Gallstone ileus managed with enterolithotomy (original) (raw)
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American Journal of Surgical Case Reports, 2023
Background: Gallstone ileus post-cholecystectomy is extremely rare surgical emergency causing mechanical bowel obstruction. This condition is usually misdiagnosed due to its non-specific clinical features. Radiological investigations are essential to evaluate and diagnose gallstone ileus cases. Case Presentation: A 92-year-old female patient, cholecystomized, presented to our hospital with a oneweek history of an acute confusional state, generalized abdominal pain, and vomiting. The physical examination showed a disoriented patient with a distended abdomen and generalized tenderness, especially in the epigastric area. Hyperactive bowel sounds were audible. Laboratory investigations were non-specific. A plain abdominal X-ray was insignificant. The abdominal ultrasound showed marked abdominal gaseous distention. Then, an abdominal CT scan was performed, revealing an impression of gallstone ileus causing small bowel obstruction with no evidence of fistula formation. So, surgical intervention was decided, and an 8-gram gallstone was exteriorized through an enterolithotomy. The postoperative period was uneventful. Discussion: Gallstone ileus is an unusual entity that often affects elderly females. The clinical features of gallstone ileus include abdominal pain, abdominal distension, nausea, and vomiting. Diagnosis of gallstone ileus relies on imaging and physical examination. Abdominal CT with contrast provides a definitive diagnostic tool. The surgical options to manage the gallstone ileus can be either one or two-staged enterolithotomy. Conclusion: Due to the rare etiologic origin of the gallstone ileus in post-cholecystectomy cases, we report the case of a 92-year-old female with an acute confusional state and generalized abdominal pain, found to be caused by detected gallstone ileus, lacking evidence of fistula formation.
Gall stone ileus: Unfamiliar cause of bowel obstruction. Case report and literature review
International journal of surgery case reports, 2018
Gallstone ileus is a rare sequela of cholelithiasis. The pathology occurs as a result of bilioenteric fistula due to erosion by the offending gallbladder stone. It is most commonly encountered in elderly females and CT imaging is diagnostic in the majority of cases. Surgical intervention aims to promptly relief the obstruction by removing the gallstone and dealing with the fistula. Morbidity and mortality are usually high since it usually occurs in elderly patients. An 88-year-old lady with multiple chronic medical problems and no history of biliary manifestation presented with acute small bowel obstruction. Abdominal CT imaging revealed a bilioenteric fistula and an impacted gallstone in the jejunum causing occlusion. Laparotomy was performed and the stone was removed via enterolithotomy. Manipulation of the cholecystoduodenal fistula was not attempted due to severe inflammatory adhesions. The patient had uneventiful postoperative course and remained symptom free on one year follow...
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2010
Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. The aim of this study was to evaluate our experience with 12 gallstone ileus cases and discuss current opinion as reported in the literature. Data of 12 patients operated between January 1998 and January 2008 with gallstone ileus were retrospectively studied. There were 12 cases (9 F, 75%; 3 M, 25%) with a mean age of 63.6 (50-80) years. Median duration of symptoms before admission to the hospital was 4.1 (1-15) days. Preoperative diagnosis was made in only five cases (41.6%). Enterolithotomy was done in nine cases (75%). Enterolithotomy and resection of the small intestine--required for decubital necrosis from the gallstone--was performed in one case (8.3%). In one case (8.3%), enterolithotomy was completed in one stage with cholecystectomy and closure of the fistula during acute surgery, and in another case (8.3%), enterolithotomy + primary suturing of the jejunal perforation was performed. There were...
Diagnosis and treatment of gallstone intestinal obstruction in an adult patient
2021
Background: Gallstone ileus, which is called Type Vb Mirizzi Syndrome, is a rare case of mechanical intestinal obstruction observed in older patients with history of cholelithiasis or cholecystitis. Diagnostic Imaging plays an important role in the management of patients with suspected gallstone ileus. X-Ray and Abdominal Computed Tomography (CT) are the preferred modality. Case presentation: The patient was diagnosed with gallstone ileus at the age of 45. The case had 10 years history of biliary colic disease. The patient who is suffered from intestinal obstruction. CT demonstrated pneumobilia involving the gallbladder, a 5, 5 cm calcified stone in the ileum and small bowel dilatation. He underwent enterolithotomy and a huge stone was removed. When gallbladder area was checked, the gallbladder was highly adherent (to colon and stomach) and was inflamed. We suspected malignancy so multipl biopsy was taken. Two-stage treatment model was planned. After the surgery, any emerging co...
Gallstone ileus resulting in strong intestinal obstruction
Sao Paulo Medical Journal, 1995
Mechanic intestinal obstruction, caused by the passage of biliary calculus from vesicle to intestine, through fistulization, although not frequent, deserve study due to the morbi-mortality rates. Incidence in elder people explains the association with chronic degenerative diseases, increasing complexity in terms of therapy decision. Literature discusses the need and opportunity for the one or two-phase surgical attack of the cholecystenteric fistule, in front of the resolution on the obstructive urgency and makes reference to Gallstone Ileus as an exception for strong intestinal obstruction. The more frequent intestinal obstruction observed is when it occurs a Gallstone Ileus impacting in terms of ileocecal valve. The authors submit a Gallstone Ileus manifestation as causing strong intestinal obstruction, discussing aspects regarding diagnostic and treatment.
Gallstone Ileus with A Typical Clinical Presentation: A Case Report
British Journal of Healthcare and Medical Research, 2023
Introduction: Gallstone ileus is a rare complication of cholelithiasis, described as a mechanical intestinal obstruction due to the impaction of one or more large gallstones within the gastrointestinal tract. It is caused by the passage of a gallstone is the simplest, to enterotomy with lithotomy plus cholecystectomy, and fistula treatment, which is a complex procedure.
Gallstone Ileus: An Unusual Cause of Intestinal Obstruction
Cureus, 2020
Gallstone ileus is an uncommon complication of gallstones and a rare cause of intestinal obstruction. Typically as a result of the formation of cholecystoduodenal fistula, surgical removal of the gallstone is the mainstay of treatment in order to relieve the intestinal obstruction. A 34-year-old male with no history of cholelithiasis presented with features of a small bowel obstruction. CT scan of the abdomen demonstrated pneumobilia, a cholecystoduodenal fistula and small bowel obstruction, features suspicious for a gallstone ileus. The patient underwent a laparotomy and removal of two gallstones via an enterotomy. He was discharged home after an uneventful post-operative period. Gallstone ileus is an uncommon cause of mechanical bowel obstruction with often delayed presentation and nonspecific symptoms. A high level of suspicion is required in at-risk groups, and in patients presenting with a bowel obstruction and known gallstone disease.