Intestinal obstruction by gall-stones. A review of 179 cases

Brockis, J. G.; Gilbert, M.

doi:10.1002/bjs.18004418705

Cited by 42 publications

(14 citation statements)

References 19 publications

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“…It complicates approximately 0.4-1.5% of all cases of gallstone disease [5,6]. In this case report, we describe a rare case of gallstone-induced small bowel necrosis with concurrent gallstone ileus, leading to a clinical presentation which is similar to appendicitis.…”

Section: Discussionmentioning

confidence: 87%

A case of gallstone-induced small bowel necrosis masquerading as clinical appendicitis

Liau

Bamber

MacFarlane

et al. 2009

Clin J Gastroenterol

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Cholecysto-duodenal fistula and gallstone ileus are well-recognised complications of gallstone disease. However, small bowel necrosis is a rare complication of gallstone disease. We describe a case of gallstone-induced ileal necrosis presenting with symptoms and signs resembling acute appendicitis. A 79-year-old woman presented to the surgical team with central abdominal pain which subsequently shifted to the right iliac fossa. Clinically, the patient had localised perotinism in the right iliac fossa with high inflammatory markers. Abdominal radiography showed no diagnostic features. Initial clinical impression was that of acute appendicitis. Given that this diagnosis was unlikely in a patient of this age, an abdominal CT scan was performed. The CT scan showed evidence of a large gallstone causing small bowel obstruction in the presence of a cholecysto-duodenal fistula. At surgery, she was found to have an area of necrosis with a pin-point perforation at the site of impaction of the gallstone in the proximal ileum. This occurred secondarily to pressure necrosis from the gallstone impacting at a site where the small bowel diameter narrows in transition from jejunum to ileum. A limited small bowel resection was performed with an uncomplicated postoperative course. This case report draws attention to a rare complication of gallstone disease which presents with a clinical picture similar to acute appendicitis. Preoperative investigation for an elderly patient who presents with an acute abdomen should include an abdominal CT scan to diagnose any rare disease processes which otherwise may not be suspected.

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Section: Discussionmentioning

confidence: 87%

A case of gallstone-induced small bowel necrosis masquerading as clinical appendicitis

Liau

Bamber

MacFarlane

et al. 2009

Clin J Gastroenterol

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“…Fatal delay may thus result before active surgical treatment is instituted and it is not surprising that mortality-rates in reported series cover a wide range but are invariably high, e.g., 71 per cent (Deckoff, 1955) and 50 per cent (Routley and Mayo, 1952). These figures also reflect the advanced years of most of the patients at risk.…”

Section: By Donald B Brown Ian F Kerr and David J Livingstone Sumentioning

confidence: 96%

“…I n a series of 179 cases reported by Brockis and Gilbert (1957) the level of obstruction was ileum 72 per cent and jejunum 17 per cent, and the remaining 11 per cent stomach, duodenum, colon, and rectum.…”

Section: Radiographic Featuresmentioning

confidence: 98%

Gall-stone obstruction

Brown

Kerr

Livingstone

1966

Journal of British Surgery

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“…Wright and Trafford (I953) considered that the cholecysto-duodenal fistula would close spontaneously, but this is probably unlikely if there are further stones in the gall-bladder. Fraser (1954) and Brockis and Gilbert (1957) suggest removal of a large stone if felt in the gall-bladder, the patient's condition permitting, at the time of the first operation. Fraser also reported exploration of the gall-bladder as a second-stage procedure following operative relief of gall-stone ileus.…”

Section: Treatmentmentioning

confidence: 99%

“…Recurrence of gall-stone ileus in the immediate post-operative period has been reported only very occasionally (Brockis and Gilbert, 1957;Grey Turner, 1932;Hand and Gilmore, I943; Foss and Summers, I942) and is usually the result of missing a second stone in the small bowel at the first operation. Recurrence after months or years is exceptionally rare and is due to further stones finding their way into the bowel from the gallbladder.…”

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confidence: 99%

Gall-Stone Ileus Recurrences and Multiple Stones

Fiddian

1959

Postgraduate Medical Journal

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Recurrence of gall-stone ileus in the immediate post-operative period has been reported only very occasionally (Brockis and Gilbert, 1957; Grey Turner, 1932; Hand and Gilmore, I943; Foss and Summers, I942) and is usually the result of missing a second stone in the small bowel at the first operation. Recurrence after months or years is exceptionally rare and is due to further stones finding their way into the bowel from the gallbladder. This paper reports 13 cases of gall-stone ileus, including two cases of recurrence, one after nine years (Case i) and one after three months (Case 6 and 6a), and three cases in which two stones were found in the small intestine at operation (Cases 3, Io and 13). The three cases illustrate obstruction by the proximal of two stones (Case io), obstruction by the distal of two stones (Case 13), and closed loop obstruction between two impacted stones (Case 3).The cases are briefly set out in the table. They were admitted to the Norfolk and NorwichHospital in a Io-year-period, April 1948 to March I958. Discussion IncidenceThere were 13 cases of gall-stone ileus in a Io-year period representing about i per cent. of all cases of intestinal obstruction. In the same period mesenteric infarction was three times and volvulus six times as common as gall-stone ileus. Vick (I932) found 2 per cent. of a large series of all types of obstruction to be due to gall-stones. However, as has been pointed out, nearly 25 per cent. of all small bowel obstructions in patients over 70 years of age, excluding strangulated herniae, were due to gall-stone ileus in his 1925-30 series.The equivalent figure for women alone would obviously be even higher. Age and SexThe average age of the patients in this series was 7I. The range was 43 to 86 and o1 of the 13 cases were over 70.There were 12 women and one man. MortalityFour deaths out of 13 cases give a mortality of 31 per cent., roughly the same as in a collected series I940-56 by Brockis and Gilbert (I957) but less than half Vick's (1932) figure of 70 per cent.for 1925-30. Recurrence Case i was relieved of obstruction by gall-stone in the ileum nine years previously in the same hospital and made an excellent recovery. There was no mention in the operation note of that time about the gall-bladder area, and on subsequent follow-up the patient was symptom free and cholecystectomy was not advised. The patient was again successfully treated by operation for this second attack of gall-stone ileus, and again there was no mention in the operation note of the gallbladder. Presumably, in view of her age (70), interval cholecystectomy was not advised.Case 6 made a satisfactory recovery after her operation on 26.7.52, when an obstructing stone in the ileum was removed. At this operation a hard mass obscured by adhesions was palpable in the gall-bladder region. The patient was readmitted three months later with a recurrent gallstone obstruction, the stone being impacted in the jejunum 3 ft. below the duodeno-jejunal flexure.The operation was difficult because of adhesions, a...

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Intestinal obstruction by gall-stones. A review of 179 cases

Cited by 42 publications

References 19 publications

A case of gallstone-induced small bowel necrosis masquerading as clinical appendicitis

A case of gallstone-induced small bowel necrosis masquerading as clinical appendicitis

Gall-stone obstruction

Gall-Stone Ileus Recurrences and Multiple Stones

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