Surgical treatment of gallstone ileus caused by cholecystoduodenal fistula: A case report

Abstract

Introduction: Gallstone ileus is a rare complication of cholelithiasis caused by bilioenteric fistula. Beside clinical examination CT scan is the considered radiological diagnostic procedure. Presentation of case: 68-year old male patient presented with epigastralgia, nausea and emesis. Abdomen was distended and diffusely painful to palpation with peritoneal irritation. Auscultation showed raised peristaltic sounds. CT scan showed aerobilia, distension of stomach, duodenum and proximal jejunum and inside it a 3.5 cm calcified round foreign body. Exploratory laparoscopy showed jejunum obstruction and chronic inflammation of gallbladder. Lifting the small bowel through small laparotomy was performed for gallstone removing. After recovery a delayed cholecystectomy and fistula closure followed. Hospital stays were short and complications-free. Conclusion: It is necessary to solve both, ileus and fistula, to prevent new bowel obstruction. The 2-step surgical procedure is a save treatment option, extraction of gallstone from bowel first, followed by delayed cholecystectomy and fistula closure.