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Abstract
Gallstone ileus is common in elderly female population. To obtain a diagnosis of gallstone ileus is a challenge requiring clinical and radiological assistance. It’s a rare cause of intestinal obstruction, accounts approximately 1-4%. Here we report a case of 56 years old lady presented with intestinal obstruction sign and symptoms. Per abdomen examination revealed generalised tenderness with sluggish bowel sound. Abdominal X-ray revealed prominent small bowel with presence of gas till rectum. CT abdomen noted intraluminal mass over distal small bowel loops mimickering intusseption. Exploratory laparotomy with small bowel enterotomy was performed. Intra-operative finding noted impacted gallstone measuring 2x3cm, 360cm from duodenal-jejunal flexure and 50cm from terminal ileum. Post-operative patient had speedy recovery and discharged home. Here we emphasize in elderly female patient presented with sign and symptoms of intestinal obstruction, diagnosis of gallstone ileus should be one of differential diagnosis.
Highlights
Gallstone ileus was first introduced by Bartholin in 1654
In view clinical finding did not correlate with imaging, we requested for CT abdomen which concluded as paralytic ileus caused by intraluminal mass over distal small bowel loops (Figure 1 & 2)
Common location of gallstone impaction is over terminal ileum and ileocaecal valve as described by Reisner and Cohen, where a study was done on 1,001 cases and identified these 2 locations [3]
Summary
Gallstone ileus was first introduced by Bartholin in 1654. He mentioned it can lead to mechanical obstruction with gastrointestinal tract. It accounts for 1-4% of all causes of mechanical obstruction, more common in female population 65 years old above and female to male ratio 3.5-6:1 [1,2,3,4]. In cases of misdiagnosis or delayed in obtaining diagnosis, morbidity and mortality is high [5].
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