Recurrent Gallstone Ileus Successfully Treated with Conservative Therapy.

Abstract

Gallstone ileus is a rare complication of cholecystolithiasis, with the majority of cases requiring surgical treatment. In this paper, we describe a case of gallstone ileus that was successfully treated twice with conservative therapy. An 85-year-old woman was admitted to our hospital because of abdominal pain and vomiting. She had previously been treated with antibiotics for cholecystitis arising from 2 gallbladder stones. Computed tomography (CT) revealed that the small bowel was dilated and that 1 of the gallbladder stones had disappeared. In addition, a 28×22-mm calcified mass was found in the small-bowel lumen. We diagnosed gallstone ileus and performed nasogastric drainage for decompression. Follow-up CT revealed migration of the impacted stone, and symptoms had improved. However, 2 months after discharge, the patient's symptoms recurred. A CT scan revealed that the small bowel was again dilated and that the remaining gallstone had disappeared from the gallbladder. A 28×25-mm calcified mass was found in the small-bowel lumen. We diagnosed recurrent gallstone ileus. Because the gallstone was almost the same size as the previous one, we selected the same conservative decompression treatment. Fourteen days after the patient was admitted, the stone was evacuated with the feces. Although many cases of gallstone ileus require surgical treatment, spontaneous passage was achieved in this case. When treatment is chosen for gallstone ileus, the patient's presentation and clinical course must be considered.