Colonic gallstone ileus: the rolling stones

Abstract

Gallstone ileus is a rare complication of cholelithiasis accounting for 1-4% of cases of intestinal obstruction with a predominance in the elderly population. Unfortunately, it has an insipid presentation and is associated with significant rates of morbidity and mortality. Controversy arises over the management of gallstone ileus, and while surgery remains the mainstay of treatment, the main point of contention surrounds the extent of surgery. We describe the case of an 85-year-old woman who presented with symptoms and signs of large bowel obstruction. Radiological evaluation revealed a 5 cm×3.5 cm gallstone impacted in the sigmoid colon. A laparoscopic-assisted enterolithotomy alone relieved the obstruction with minimal surgical insult and allowed for a swift and uneventful recovery. Our case emphasises the need for a high index of suspicion for the condition as well as highlighting the advantages of the use of laparoscopic surgery in an emergency setting.

Figure 1

Pneumobilia and a thickened gallbladder wall.

Figure 2

A 5 cm×3.5 cm gallstone lodged in the sigmoid colon.

Figure 3

Impacted gallstone at 40 cm with surrounding mucosal irritation.

Figure 4

Ink-marked colon delivered through a suprapubic incision.

Figure 5

Longitudinal enterotomy to remove the stone.

Figure 6

Gallstone measuring over 6 cm×4 cm in size.