Gallstone ileus with spontaneous evacuation: A case report

Abstract

A 65-year-old man was referred to our hospital for abdominal pain. He had a history of enterotomy with stone extraction for gallstone ileus. On abdominal computed tomography, a stone measuring 32 × 28 mm lodged in the jejunum was identified. He was diagnosed with gallstone ileus and treated using a nasal ileus tube. Four days after admission, computed tomography showed that the stone had passed into the rectum. The gallstone was spontaneously evacuated on the same day. A fistula with the gallbladder was found in the duodenal bulb. The patient's condition improved, and he was discharged 9 days after admission.

Keywords: cholecystoduodenal fistula; gallstone; ileus; spontaneous evacuation.

Figure 1

A, Computed tomography (CT) showing gallstone (arrow) lodged in the jejunum and intestinal dilation on the oral side of the intestine. The gallstone measured 32 × 28 mm in the CT image. B, The gallstone (arrow) passed into the rectum 4 d after admission. It is surrounded with the contrast medium. C, The gallstone confirmed using an endoscope in the rectum. D, The gallstone evacuated spontaneously

Figure 2

A, The presence of cholecystoduodenal fistula (arrowhead) was suspected in the computed tomography image at the time of admission. No tumor was found in the gallbladder (white arrow). B,C, Cholecystoduodenal fistula found in the posterior wall of the duodenal bulb (black arrow). D, Gallbladder and bile duct imaged using contrast medium injection from the fistula of the duodenal bulb