Gallstone ileus managed with enterolithotomy

Abstract

Although gallstone disease is classically associated with the inflammatory sequela of cholecystitis, other presentations include gallstone ileus, Mirizzi syndrome, Bouveret syndrome and gallstone ileus. Gallstone ileus occurs when a gallstone passes from a cholecystoduodenal fistula into the gastrointestinal tract and causes obstruction, usually at the ileocaecal valve. It represents an uncommon complication of cholelithiasis, accounting for 1%–4% of all cases of mechanical bowel obstruction and 25% of all cases in individuals aged >65 years. It has a female predilection. Clinical presentation depends on the site of the obstruction. Diagnosis can prove challenging with the diagnosis rendered in 50% of cases intraoperatively. The authors present the case of a 79-year-old woman with a 10-day history of abdominal pain, nausea, vomiting and episodes of loose stools. An abdominal radiograph showed mildly distended right small bowel loops. Further investigation with a CT of the abdomen and pelvis demonstrated small bowel obstruction secondary to a 3.3 cm calculus within the small bowel. She underwent a laparotomy and a 5.0×2.5 cm gallstone was evident, causing complete obstruction. An enterolithotomy was performed. Her postoperative course was complicated by Mobitz type II heart block requiring pacemaker insertion. This paper will provide an overview of the clinical presentation, investigations and management of gallstone ileus. It provides a cautionary reminder of considering gallstone ileus in the differential diagnosis in elderly patients presenting with bowel obstruction and a history of gallstone disease.

Gallstone Ileus: An Improbable Cause of Mechanical Small Bowel Obstruction

“…This occurs due to chronic pressure necrosis from large stones in an inflamed gallbladder, forming a cholecystoenteric fistula, allowing gallstones direct access to the gut. Usually the fistula is located between the gallbladder and duodenum (first and second part), but fistulas to the stomach and colon have been described [ 6 ]. The majority of the gallstones smaller than 2-2.5 cm may pass spontaneously through a normal gastrointestinal tract.…”

An Unusual Cause of Duodenal Ulceration

“…1 The passage of large gallstones from the gallbladder into the small bowel occurs as a result of pressure necrosis resulting in a spontaneous cholecystoenteric fistula. 2 Obstructive symptoms are more common when the diameter of the gallstone is >25 mm. 2 The findings of a hard, smooth, and nonfriable mass during endoscopy is suggestive of gallstone impaction.…”

“…2 Obstructive symptoms are more common when the diameter of the gallstone is >25 mm. 2 The findings of a hard, smooth, and nonfriable mass during endoscopy is suggestive of gallstone impaction. 1 The sensitivity of a CT scan for diagnosing gallstone ileus is 93%.…”

“…2 Surgical relief of the obstruction is mainstay of management, which includes enterolithotomy, cholecystectomy, and fistula closure as a 1-or 2-stage procedure. 1,2 Keywords: Non-Variceal Upper Gastrointestinal Bleeding; Gallstone; Gallstone Ileus.…”

Gallstone ileus caused by a gallstone impacted at a cecum neoplasm – A case report

“…It is a rare complication of chronic cholelithiasis [ 4 , 5 ], representing less than 5% of all cases of mechanical bowel obstruction [ 6 , 7 ].…”