Rare case of duodenal obstruction by a gallstone

Abstract

We present a new case of gallstone ileus, review the literature and reassess the diagnostic and surgical strategies implemented for the treatment of this uncommon cause of ileus. Gallstone ileus accounts for 1-4% of all cases of enteric obstruction [3]. It was first reported by Bartholin in 1654 but was fully described by Naunyn in 1892 [1]. We present the case of a 62-year-old woman that presented with symptoms of ileus and subsequently underwent surgery for a gallstone logged between the 3rd and 4th part of the duodenum. The patient made a full recovery and had a normal postoperative period. The diagnosis of the disease is made either by a plane abdominal x-ray in a standing position or by means of an abdominal CT scan [11,12]. The main symptom is bile containing regurgitations [3,9], and treatment is surgical [4].The medical history of the patient revealed a known chololithiasis, elevated blood pressure and peripheral vascular disease that was being treated with valsartan-hydrochlorothiazide and acetylsalicylic acid. Quetiapine and pregabalin were also administered by a psychiatrist. The patient's family history did not reveal any major pathology. Clinical examinationThe patients general status was poor. Her blood pressure was 85/65mmHg, heart rate 72 bpm and oxygen saturation (SaO2) 96%. Her abdomen was neither contracted nor did the patient report pain when examined. Epigastric flatulence was noted. Auscultation of the abdomen revealed marked bowel movements.A Levin tube was placed and the gastric content was emptied (dark green-brown in colour with food remnants) Blood testsWBC: 17.830/μl (neu 86.8% Lym 7.4%), Hb 13g/dL, PLT 221.000/μL, CRP 0.4mg/dL, SGOT 53IU/L, SGPT 16IU/L, ALP 117 IU/L, γ-GT 55 IU/L, total bilirubin 0.61mg/dl, LDH 192 Iu/L, CK 39 IU/L, serum amylase 189 IU/L, urea 76 mg/dL, creatinine 1.36mg/dL, Mg 1.94 mg/dL. Abdominal X-rayThe X-ray revealed dilatation of the stomach, pneumobilia and radio opaque formation b/w L3 -L4. Ultrasound