Colonic perforation by a large gallstone: A rare case report

Abstract

Introduction: Herein we present the case of an 86-year-old woman with gallstone perforation of the sigmoid colon.

Presentation of case: An 86-year-old woman with known cholelithiasis presented to our office with one week of abdominal pain and nausea. X-rays taken at presentation demonstrated pneumobilia, and CT scan showed a 3.5cm gallstone in the sigmoid colon. Medical management was unsuccessful in passing the stone, and a colonoscopy on day 4 was unsuccessful in incorporating the stone. Subsequent clinical deterioration prompted a laparotomy, where a perforation was discovered. A Hartmann's procedure was performed and the patient recovered after a complicated post-operative course.

Discussion: Gallstone ileus is an uncommon, but medically important, cause of bowel obstruction. This presentation is considered a surgical emergency and thus prompt identification and removal is essential. Obstructions tend to occur in either the stomach or along the various segments of the small intestine but have been reported in the colon as well.

Conclusion: In cases of gallstones that manage to pass into the large intestine, it is prudent to attempt conservative measures for passage. Failure to do so should raise suspicion of a possible stricture, either benign or malignant, preventing its evacuation. Earlier surgical intervention should be considered in these cases.

Keywords: Colon; Gallstone; Obstruction; Perforation; Sigmoid.

Fig. 1

An abdominal film shows dilated small bowel and pneumobila (black arrow).

Fig. 2

Coronal, sagittal, and transverse CT imaging shows a 3.5 cm gallstone (white arrows) in the sigmoid colon.

Fig. 3

A water-soluble enema demonstrates the gallstone (black arrow) at the level of the sigmoid colon.

Fig. 4

3.7 cm × 3.0 cm × 2.7 cm barrel-shaped gallstone.

Fig. 5

Area of stricture in the sigmoid colon around the level of the perforation with a luminal circumference narrowed to 3.5 cm.