Recurrent gallstone ileus due to a residual gallstone: A case report and literature review

Abstract

HighlightsRecurrence should be considered in all patients with gallstone ileus.A review of pre-operative imaging and meticulous inspection of the bowel and gallbladder should always be undertaken.Faceted gallstones should alert the surgeon to the potential presence of a second stone.Cholecystolithotomy should be considered as a safer alternative to cholecystectomy with fistula repair in high risk patients.

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.…”

“…It is caused by the passing and impaction of a gallstone in the bowel lumen, usually through a fistula connecting the gall bladder with the gastrointestinal tract. It grounds for 0.3–5.3% of all bowel obstruction causes [1] . The fistula is created due to the inflamed gall bladder being in contact with segments of the bowel and the pressure caused from a gallstone on the bladder wall.…”

“…Recurrent episodes of cholecystitis also play a major role in the formation of the fistula [2] . The most common site of connection is the duodenum (69–70%), then parts of the colon (14%) and the small bowel (6%) [1] , [3] . Presentation can be with nonspecific abdominal symptoms including nausea, vague abdominal pain and vomiting, or as a typical bowel obstruction manifestation, with acute abdominal pain and distension.…”

“…Those include conservative, surgical and non-surgical methods. Usually, gallstones ≥2–2.5 cm are able to cause a complete obstruction, therefore smaller gallstones can present as ‘rolling stones’ moving inside the bowel lumen and causing a phenomenon called ‘tumbling phenomenon’ [1] . Patients can be helped with the use of laxatives in order to defecate smaller gallstones and dissolve the obstruction.…”

Unusual Presentation of Recurrent Gallstone Ileus: A Case Report and Literature Review

“…Gallstone ileus (GSI) is a rare form of bowel obstruction that occurs in 0.4–1.5% of patients with cholelithiasis [1]. Gallstones (>2 cm) are thought to enter the duodenum through a cholecystoduodenal fistula which forms as a rare complication of gallstone disease.…”