Small bowel obstruction with gallstone. Case report

Abstract

Clinical case study of a cholelithiasis rare complication — gallstone small bowel obstruction with cholecystoduodenal fistula has been presented. According to several studies, the frequency of gallstone small bowel obstruction is approximately 0.3 to 4 % of all cases of small bowel obstruction, and 0.2 to 0.6 % of patients with cholelithiasis. A patient at the age of 69 years, was admitted to the surgical department in urgently 07.11.2017 with the diagnosis of acute gallstone small bowel obstruction. The diagnosis was based on complaints, anamnesis, clinical signs, additional imaging methods (radiography and ultrasound examination of the abdominal cavity organs). The patient was operated urgently. In the lumen of the small intestine at a distance of 120 cm from the Treitz ligament a concrement up to 33 × 26 mm was found, proximal to the concrement the loops of the small intestine were expanded to 42 mm, filled with intestinal contents and gas, distal to the concrement, the small intestine collapsed. The dense infiltrate up to 6 × 4 cm, involving the gallbladder and duodenum was visualized during operation in the subhepatic space. There was no bile and intestinal content leakage in the infiltration area. Enterotomy, lithoextraction, enterorrhaphia were performed. Dissociation of the cholecystoduodenal fistula was not performed due to the severity of the patient’s condition and the presence of small bowel obstruction. The postoperative period was without complications. The patient was discharged in a satisfactory condition. An ultrasound examination of the abdominal cavity organs allowed to diagnose this pathology before the operation, demonstrating high sensitivity and specificity of the method.