Case series of gallstone ileus with one- or two-stage surgery.

Background : Gallstone ileus is a rare complication of cholelithiasis and is an uncommon cause of intestinal obstruction accounting for 1%–4% of mechanical bowel obstructions. This usually results from luminal impaction of one or more gallstone.
 Case Presentation : A 86-year-old male presented with the history of bilious vomiting for 15 days and abdominal distension for 8 days and diagnosed as a case of intestinal obstruction due to gall stone ileus. He was treated surgically by laparotomy followed by enterotomy and removal of gall stone were performed from the proximal ileum.
 Conclusion : Early diagnosis and treatment are important otherwise adverse effect of mechanical bowel obstruction leads to bad prognosis.
 Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 57-59

Gallstone ileus is a rare cause of intestinal obstruction. It is due to biliary-enteric fistula complicating cholelithiasis. It occurs mostly in elderly women with a heavy history of associated comorbidities. The clinical presentation is characterized by insidious and intermittent obstructive symptoms, which often might delay diagnosis. The mainstay treatment is surgical, which consisted of an urgent enterolithotomy allowing prompt relief of obstruction. The management of bilio-enteric fistula is not mandatory in the same procedure and is discussed based upon patient characteristics. Herein, we report a female case of 80-year-old, with a history of diabetes mellitus and morbid obesity. The patient presented with an abdominal acute pain associated with vomiting, evolving along five days. The physical examination showed a heart rate of 110 beats per minute, blood pressure of 110/70 mmHg and body temperature of 37.6°C. The abdominal examination revealed a slightly tympanic abdomen with diffuse tenderness. The initial biological blood assessment showed a slight increase of C-reactive protein at 21 mg/L, and leukocytosis of 14x109 elements/L. The blood investigation was normal. The CT scan of the abdomen showed dilated small bowel loops upstream of a large gallstone with a calcified rim. These findings are consistent with gallstone ileus (A). After adequate resuscitation with intravenous fluids, the patient underwent an urgent midline mini-laparotomy. The surgical exploration revealed the presence of a gallstone in the ileus resulting in an intestinal obstruction (B). The gallstone was removed through longitudinal enterotomy and the defect was closed transversally (C). Given the high anesthetic risk for the patient and the need for a shortened laparotomy, it has been decided not to treat the cholecystitis and the enterobiliary fistula. The patient had an uneventful recovery and has no symptoms within 6 months follow-up.

Gallstone ileus is a rare complication of cholelithiasis and an uncommon cause of intestinal obstruction. It accounts for about 1-4% of all mechanical bowel obstructions. The clinical symptoms and signs of gallstone ileus are mostly nonspecific. An 82-year-old woman with recurrent diverticulitis of the sigmoid was admitted because of cramping right upper abdominal pain and signs of large bowel obstruction. Abdominal ultrasound revealed pneumobilia and severe diverticulitis of the sigmoid with signs of ileus. Endoscopic retrograde cholangiography visualized the cholecystoenteric fistula. In addition, computed tomography (CT) scan revealed two stones 3 cm in diameter leading to nearly complete obstruction of the sigmoid. The patient underwent an open cholecystectomy, closure of the cholecystoenteric fistula, and sigmoidectomy. This case report demonstrates that relative stenoses of the sigmoid due to recurrent diverticulitis may predispose to the impaction of foreign bodies. Gallstone ileus is a rare but important differential diagnosis of intestinal obstruction. Ultrasound and CT scans are very helpful in diagnosing gallstone ileus. The treatment is surgical. Unfortunately, surgical therapy of this rare complication is associated with a high morbidity and mortality rate due to multiple comorbidities and age-related problems of these patients. The management of patients with gallstone ileus should be individualized.

Gallstone ileus is an uncommon cause of intestinal obstruction in the elderly. It is typically recognized on computed tomography by the presence of pneumobilia and a gallstone in the right iliac fossa. Nonetheless, it is important to consider that gallstone ileus may represent the presentation of another pathology rather than an entity on its own. Here, we report successful retrieval of a gallstone that was causing ileus. Intraoperatively, the gallstone was noted lodged in the terminal ileum distal to an incidentally noted Meckel’s diverticulum. The gallstone was milked proximally into the Meckel’s diverticulum and the base was transected. This case illustrates a rare, but unique, surgical technique utilizing a small bowel diverticulum as a vector for stone removal.

Gallstone ileus with Rigler’s triad in a 68-year-old male: An uncommon cause of intestinal obstruction

None declared.

Patient: Male, 71-year-oldFinal Diagnosis: Gallstone ileusSymptoms: Abdominal pain • nausea • obstipation • small bowel obstruction • vomitingClinical Procedure: EnterotomySpecialty: SurgeryObjective:Unusual clinical courseBackground:Gallstone ileus is an uncommon cause of intestinal obstruction. Rigler’s classic triad for a gallstone ileus includes the following: small bowel obstruction, air in the biliary tract, and an obstructing gallstone. This triad, however, is not always observed. We present an unusual case of a gallstone present in the small bowel for several years prior to presenting with an acute obstruction.Case Report:A 71-year-old man presented with 3 days of lower abdominal pain, constipation, and abdominal distension, with his last reported bowel movement 3 days prior. The patient’s vitals were stable, with a white blood cell count of 11.47×109/L and no lactic acidosis. Abdominal exam was significant for bilateral lower-quadrant tenderness and mild distension. Findings on abdominal computed tomography revealed a large foreign body in the distal small bowel, with evidence of proximal small bowel obstruction. Review of imaging from 4 years prior incidentally revealed the foreign body more proximally in the jejunum. Laparoscopy and enterotomy were performed with removal of a 4×4 cm gallstone encased in fecal material. The patient recovered well from surgery and had no complications.Conclusions:A 71-year-old man presented with lower abdominal pain and distension. Work-up revealed a small bowel obstruction secondary to a presumed foreign body, later found to be a gallstone. We present a highly unusual presentation of a gallstone ileus, with radiographic evidence of an enteric gallstone present 4 years prior, with no evidence of pneumobilia or biliary-enteric fistula in current or previous computed tomography scans.

Long-term Results of Extracorporeal Shockwave Lithotripsy and Endoscopic Therapy for Pancreatic Stones

Gallstone ileus is an uncommon cause of intestinal obstruction and occurs following the formation of a cholecystoenteric fistula, permitting passage of gallstones into the gastrointestinal tract. Impaction of a gallstone in the sigmoid colon is rare and is usually at sites of previous colonic disease. Definitive management can be challenging due to the advanced age and co-morbidity usually seen in this group of patients. We describe a patient successfully managed with on-table endoscopy and, under local anaesthetic, the formation of a left iliac fossa trephine loop colostomy, permitting an enterolithotomy to deliver the stone whilst accommodating for severe pre-existing distal sigmoid diverticular disease. A review of the literature identified various endoscopic and surgical treatments that, depending on local expertise and patient characteristics, can be considered on a case-by-case basis. We advocate the management described in this case for patients presenting with large bowel obstruction due to gallstone ileus, with a background of diverticular disease and who are not fit for general anaesthetic or formal bowel resection, as an alternative to medical palliation alone.

Gallstone ileus is an uncommon complication of gallstones and a rare cause of intestinal obstruction. Typically as a result of the formation of cholecystoduodenal fistula, surgical removal of the gallstone is the mainstay of treatment in order to relieve the intestinal obstruction. A 34-year-old male with no history of cholelithiasis presented with features of a small bowel obstruction. CT scan of the abdomen demonstrated pneumobilia, a cholecystoduodenal fistula and small bowel obstruction, features suspicious for a gallstone ileus. The patient underwent a laparotomy and removal of two gallstones via an enterotomy. He was discharged home after an uneventful post-operative period. Gallstone ileus is an uncommon cause of mechanical bowel obstruction with often delayed presentation and non-specific symptoms. A high level of suspicion is required in at-risk groups, and in patients presenting with a bowel obstruction and known gallstone disease.

Gall-stone ileus is a well-known, but uncommon cause of intestinal obstruction. Preceding symptoms of biliary disease are absent in most cases and the presentation is often vague and non-specific (Reisner and Cohen, 1994). Plain abdominal X-ray is often inconclusive, but may show classical signs (Rigler et al, 1941). Ultrasound and computed tomography (CT) are useful in making the diagnosis (Summerton et al, 1995; Swift and Spencer, 1998). This paper presents abdominal X-ray, sonographic and CT findings in a patient with surgically proven gall-stone ileus.

Gallstone ileus in the absence of cholecystoduodenal fistula

Gallstone ileus is very rare complication of cholelithiasis. As it is usually a disease of the elderly, the morbidity and mortality associated with it is high due to the presence of co-morbidities. This is additionally made worse by the delay encountered before reaching diagnosis which often demands a high index of suspicion. In Ethiopia, a country where intestinal obstruction is seen to be one of the common presentations in the emergency surgical department, gall stone has never been seen to be reported as a cause. Thus we present this rare case and discuss the mode of presentation, diagnostic difficulties and differing treatment options. We report the case of an 80-year old lady who presented with signs and symptoms of small intestinal obstruction. Upon exploration we were astonished to find the cause of the obstruction to be a gallstone which was removed by simple ileostomy. Postoperative course was uneventful.Keywords: gallstone ileus, intestinal obstruction, gallstone

Bouveret's Syndrome Complicated by Classic Gallstone Ileus: Progression of Disease or Iatrogenic?

BACKGROUND: Gallstone ileus (GI) is a mechanical obstruction in the intestinal lumen due to gallstones. Its prevalence is very low, but it possesses a high mortality rate. It is commonly found in older female population. CASE REPORT: We reported a case of GI in a 61-year-old Chinese female, who presented with acute onset of abdominal pain, nausea, and intermittent vomiting. On water-soluble contrast follow-through examination, she showed total bowel obstruction on the level of terminal ileum due to suspected gallstone. Exploratory laparotomy with procedure of enterolithotomy and stone removal by milking the bowel distal to the stone were performed. Post-operative course was uneventful, but the patient was discharged at post-operative day 8. Furthermore, the patient underwent cholecystectomy and fistula repair in the following days (two-stage surgery). She was followed up in the clinic for 12 months and the patient remained asymptomatic. CONCLUSION: GI is a rare medical condition with a high mortality rate, commonly affecting females and elder population. It must be considered in a patient with bowel obstruction, especially with a history of cholelithiasis. Many clinicians prefer enterolithotomy alone, followed by cholecystectomy at later date, because of its lower morbidity and report high spontaneous fistula closure.