Colonic gallstone ileus: the rolling stones

Abstract

SUMMARYGallstone ileus is a rare complication of cholelithiasis accounting for 1-4% of cases of intestinal obstruction with a predominance in the elderly population. Unfortunately, it has an insipid presentation and is associated with significant rates of morbidity and mortality. Controversy arises over the management of gallstone ileus, and while surgery remains the mainstay of treatment, the main point of contention surrounds the extent of surgery. We describe the case of an 85-yearold woman who presented with symptoms and signs of large bowel obstruction. Radiological evaluation revealed a 5 cm×3.5 cm gallstone impacted in the sigmoid colon. A laparoscopic-assisted enterolithotomy alone relieved the obstruction with minimal surgical insult and allowed for a swift and uneventful recovery. Our case emphasises the need for a high index of suspicion for the condition as well as highlighting the advantages of the use of laparoscopic surgery in an emergency setting. BACKGROUND

Iléus biliaire colique: une cause rare d’occlusion colique

“…L'iléon terminal est la localisation la plus fréquente d'obstruction par un calcul biliaire (60 à 70%), car la valvule iléo-caecale est le lieu d'impaction le plus fréquent du calcul [2]. Le jéjunum est le site d'obstruction dans 15 à 20% des cas, et le calcul ne s'impacte dans le bulbe duodénal que dans 10% des cas.…”

“…L'obstruction du colon par un calcul biliaire est exceptionnelle. L'iléus biliaire avec obstruction colique ne représente que 2 à 8% des iléus biliaires [2, 3]. Elle implique le plus souvent l'existence d'une fistule directe entre les voies biliaires et le côlon, car le calcul ne franchit qu'exceptionnellement la valvule de Bauhin.…”

“…Les fistules biliodigestives au travers desquelles migrent les calculs, constituent une complication peu fréquente chez les patients porteurs d'une lithiasevésiculaire biliaire (1 à 3 % avec une sex-ratio de 3 femmes pour un homme) [1]. Les localisations des fistules par ordre décroissant de fréquence sont [2]: cholécysto-duodénales: 76%; cholécysto-coliques: 15%; cholécysto-cholédociennes: 3%; multiples: 3%; cholécysto-gastriques: 2%; cholédoco-duodénales: 1%.…”

A novel surgical approach for treatment of sigmoid gallstone ileus

“…This ranged from defunctioning sigmoid colostomy to large bowel resection and colostomy formation 3 4. Laparoscopically assisted enterolithotomy5 or extracorporeal shockwave lithotripsy6 were used less frequently. The surgical technique we have discussed has not been reported before in the peer-reviewed literature.…”

Gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after bile duct cancer surgery: a case report

“…Rarely, colonic gallstones can happen if there is a gallbladder-colon fistula. 5 7 More rarely, gallstone ileus has been reported even in absence of a bilioenteric fistula. 8 This can be explained by the entrance of the gallstones through the Vater papilla and growth within the small bowel lumen.…”