Gallstone ileus: Case report

Abstract

Introduction: Gallstone ileus is a mechanical bowel obstruction caused by a gallstone passed to the bowel through the biliodigestive fistula. It is a rare complication of cholelithiasis and accounts for 1-4% of all cases of mechanical bowel obstructions but up to 25% in patients over 65 years of age. Case report: Seventy-nine-year old female referred to the surgeon for examination. She had been experiencing upper abdominal pain, vomiting of bilous content and the absence of transit of feces and flatus during the previous four days. The abdomen was distended, soft and non -tender. Liver and spleen were not enlarged and renal succussion was negative. There were no signs of hernias. The bowel sounds were present. There was no stool on the rectal examination. Blood tests revealed an elevated total leukocyte count with granulocytosis and elevated blood urea level. A plain abdominal film demonstrated dilated bowel loops and air fluid levels in the ileocoecal region without the signs of pneumoperitoneum. The nasogastric tube was inserted and the patient was treated with intravenous fluids during the observation. Abdominal radiograph done 8h later showed no changes and we decided to perform exploratory laparotomy. During the operation, the gallstone ileus was diagnosed and enterotomy, stone extraction, cholecystectomy and fistula reparation were performed. The postoperative course was uneventful. Conclusion: Gallstone ileus is a rare condition that must be taken into consideration in elderly patients with previous history of cholelithiasis. The diagnosis is usually intraoperative and the mortality rate is high due to delayed diagnosis, advanced age and comorbidities.