Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016:26:193-6.
doi: 10.1016/j.ijscr.2016.07.050. Epub 2016 Jul 30.

Bowel obstruction and perforation due to a large gallstone. A case report

Affiliations

Bowel obstruction and perforation due to a large gallstone. A case report

Georgios Sahsamanis et al. Int J Surg Case Rep. 2016.

Abstract

Introduction: Gallstone bowel obstruction is a rare form of mechanical ileus usually presenting in elderly patients, and is associated with chronic or acute cholecystitis episodes.

Case presentation: We present the case of an 80year old female with abdominal pain, inability to defecate and recurrent episodes of diarrhea for the past 8 months. CT examination uncovered a cholecystoduodenal fistula along with gas in the gall bladder and the presence of a ≥2cm gallstone inside the small bowel lumen causing obstruction. Patient was admitted to the operating room, where a 3.2cm gallstone was located in the terminal ileus. A rupture was found in the antimesenteric part of a discolored small bowel segment, approximately 60cm from the ileocaecal valve, through which the gallstone was recovered. The bowel regained its peristalsis, and the rupture was debrided and sutured. Patient was discharged uneventfully on the 6th postoperative day.

Discussion: Gallstone ileus is caused due to the impaction of a gallstone inside the bowel lumen. It usually passes through a fistula connecting the gallstone with the gastrointestinal tract. It can present with nonspecific or acute abdominal symptoms. CT usually confirms the diagnosis, while there are a number of treatment options; conservative, minimal invasive and surgical. Our patient was successfully relieved of the obstruction through recovery of the gallstone using open surgery, with no repair of the fistula.

Conclussion: Although rare, gallstones must be suspected as a possible cause of bowel obstruction, especially in elderly patients reporting biliary symptoms.

Keywords: Biliogastric fistula; Case report; Gallstone bowel obstruction; Gallstone ileus; Rigler’s triad.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
CT examination showing a cholocystoduodenal fistula with air and gastrografin inside the gall bladder.
Fig. 2
Fig. 2
CT examination showing bowel distension and a 2 cm in diameter calcified gallstone inside the small bowel lumen.
Fig. 3
Fig. 3
Bowel rupture site.
Fig. 4
Fig. 4
The location of the gallstone inside the bowel lumen and near the terminal ileum. Next to it the ruptured bowel segment.
Fig. 5
Fig. 5
(a,b) Removal of the gallstone through the ruptured site.
Fig. 6
Fig. 6
A 3.2 cm gallstone found to be the cause of the obstruction.
Fig. 7
Fig. 7
Suturing of the ruptured bowel.

References

    1. Apollos J.R., Guest R.V. Recurrent gallstone ileus due to a residual gallstone: a case report and literature review. Int. J. Surg. Case Rep. 2015;13:12–14. - PMC - PubMed
    1. Nuno-Guzman C.M., Marin-Contreras M.E., Figueroa-Sanchez M., Corona J.L. Gallstone ileus: clinical presentation, diagnostic and treatment approach. World J. Gastrointest. Surg. 2016;8(1):65–76. - PMC - PubMed
    1. Conzo G., Mauriello C., Gambardella C., Napolitano S., Cavallo F., Tartaglia et al E. Gallstone ileus: one-stage surgery in an elderly patient: one-stage surgery in gallstone ileus. Int. J. Surg. Case Rep. 2013;4(3):316–318. - PMC - PubMed
    1. Ayantunde A.A., Agrawal A. Gallstone ileus: diagnosis and management. World J. Surg. 2007;31(6):1292–1297. - PubMed
    1. Lee C.H., Yin W.Y., Chen J.H. Gallstone ileus with jejunum perforation managed with laparoscopic-assisted surgery: rare case report and minimal invasive management. Int. Surg. 2015;100(5):878–881. - PMC - PubMed