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Case Reports
. 2015 May;100(5):878-81.
doi: 10.9738/INTSURG-D-14-00265.1.

Gallstone ileus with jejunum perforation managed with laparoscopic-assisted surgery: rare case report and minimal invasive management

Cheng-Hung Lee  1 , Wen-Yao Yin, Jian-Han Chen
Affiliations
Case Reports

Gallstone ileus with jejunum perforation managed with laparoscopic-assisted surgery: rare case report and minimal invasive management

Cheng-Hung Lee et al. Int Surg. 2015 May.

Abstract

Gallstone ileus is an uncommon complication of cholelithiasis. Most patients affected by gallstone ileus are elderly and have multiple comorbidities. Symptoms are vague and insidious, which may delay the correct diagnosis for days. Here we are reporting an uncommon complication of gallstone ileus. We report on a 70-year-old man with small bowel obstruction at the jejunum due to an impacted stone, which led to necrosis and perforation of the proximal bowel wall. Laparoscope-assisted small bowel resection with enterolithotomy was used to successfully treat the patient's perforation and obstruction. His recovery was uneventful. Gallstone ileus commonly presents with bowel obstruction, but intestinal perforation occurs very rarely. A laparoscopic approach can provide both diagnostic and therapeutic roles in management.

Keywords: Gallstone ileus; Intestinal obstruction; Jejunal perforation; Laparoscopic surgery.

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Figures

Fig. 1
Fig. 1
(a) Abdominal CT scan upon admission. Note the inflammatory change around the entire gallbladder without gallstones. D, duodenum; arrowhead, gallbladder. (b) Abdominal CT scan 1 year after surgery. Note the lack of inflammation around the gallbladder. D, duodenum; arrowhead, gallbladder.
Fig. 2
Fig. 2
The missing stone was found in the lumen of the small intestine over the lower abdomen. Asterisk, gallstone.
Fig. 3
Fig. 3
The stone (asterisk) impacted in the lumen could be easily palpated. Note the 4 areas of necrotic wall (arrowhead) on the left in this photo, and some purulent coating in the jejunum.
See this image and copyright information in PMC

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