Gallstone Ileus With Jejunum Perforation Managed With Laparoscopic-Assisted Surgery: Rare Case Report and Minimal Invasive Management

Abstract

Gallstone ileus is an uncommon complication of cholelithiasis. Most patients affected by gallstone ileus are elderly and have multiple comorbidities. Symptoms are vague and insidious, which may delay the correct diagnosis for days. Here we are reporting an uncommon complication of gallstone ileus. We report on a 70-year-old man with small bowel obstruction at the jejunum due to an impacted stone, which led to necrosis and perforation of the proximal bowel wall. Laparoscope-assisted small bowel resection with enterolithotomy was used to successfully treat the patient's perforation and obstruction. His recovery was uneventful. Gallstone ileus commonly presents with bowel obstruction, but intestinal perforation occurs very rarely. A laparoscopic approach can provide both diagnostic and therapeutic roles in management.Key words: Gallstone ileus -Jejunal perforation -Laparoscopic surgery -Intestinal obstruction G allstone ileus is characterized by intestinal obstruction due to intraluminal impaction of one or more gallstones. It is an uncommon but serious complication of cholelithiasis and accounts for 1% to 3% of cases of patients who undergo surgery for bowel obstruction.1,2 A cholecystoduodenal fistula is the most common tract. 3 Most patients are elderly and female, and the average age range is 65 to 75 years. In spite of treatment, the mortality rate ranges from 10% to 20%. 4,5 Gallstone ileus with proximal small bowel perforation is rare, and fewer than 10 cases have been

Bowel obstruction and perforation due to a large gallstone. A case report

“…Patients usually report a medical history of gallstones or recurrent episodes of cholecystitis up to 80% of cases [2] , [4] . Gallstone ileus seems to appear more frequently in elderly population above the age of 65, showing a preference in women, since they are more prone to acute or chronic cholecystitis than men, with a ratio of 3–1 [1] , [3] , [5] . Our patient reported no such medical history, although she did report recurrent episodes of diarrhea for the past 8 months.…”

“…Patients can be helped with the use of laxatives in order to defecate smaller gallstones and dissolve the obstruction. Non-surgical methods include endoscopic extraction of the gallstones or the application of U/S guided extracorporeal shock wave lithotripsy (ESWL) [2] , [5] , [9] , [10] . Surgical management of gallstone obstruction has seen much controversy with two methods being the most applied ones.…”

Gallstone Ileus with associated perforated small bowel diverticulitis

“…Perforation can occur at the site of impaction or previous sites of obstruction due to pressure necrosis of the jejunal wall due to the gallstone. Alternatively, as highlighted in our case, perforation of a pre-existing jejunal diverticulum may occur [6,8]. The prevalence of jejunal diverticula is approximately 1% in the general population and it affects a similar age group to gallstone ileus, with its prevalence increasing in the elderly and peaking in the sixth and seventh decades [8].…”

“…Gallstone ileus with proximal small bowel perforation is very rare [6]. In particular, there have been very few reports of gallstone ileus complicated by jejunal perforation [6,7].…”

“…Gallstone ileus with proximal small bowel perforation is very rare [6]. In particular, there have been very few reports of gallstone ileus complicated by jejunal perforation [6,7]. Perforation can occur at the site of impaction or previous sites of obstruction due to pressure necrosis of the jejunal wall due to the gallstone.…”