Gallstone Ileus: An Unlikely Cause of Mechanical Small Bowel Obstruction

Gallstone Ileus: Clinical Presentation and Radiological Diagnosis

The term "gallstone ileus" refers to intestinal obstruction brought on by a gallstone lodged within its lumen. The gallstone travels through a fistula that develops because of the constant pressure it exerts on the gall bladder. The symptoms are vague and confounding which can commonly lead to delay in diagnosis. The preferred imaging technique is a computed tomography scan. The diagnosis is confirmed by the identification of Rigler's Triad on a CT scan, which includes a small intestinal obstruction, pneumobilia, and an ectopic stone in the intestine. The condition is associated with several complications and needs to be treated with emergency surgery. This case demonstrates how a patient could have non-specific symptoms and how early detection by imaging was crucial to the patient's treatment.

Gallstone Ileus Caused by Migration of Gallstone Through Cholecystoduodenal Fistula Resulting in Small Bowel Obstruction

Gallstone ileus is a rare condition characterized by mechanical obstruction of the intestine due to gallstone impaction. Diagnosis is based on clinical history, symptoms, and characteristic Computed Tomography (CT) scan findings. Treatment typically involves surgical extraction of gallstones, with laparoscopy as an effective and potentially safer approach. Here, we describe a case of an 84-year-old woman with gallstone ileus presenting with small bowel obstruction.

Case series of gallstone ileus with one- or two-stage surgery

Gallstone ileus is an uncommon cause of intestinal obstruction. It may present with typical symptoms of intestinal obstruction with or without biliary sepsis. Its management strategies vary depending on the patient and operative factors. Enterotomy and stone removal alone versus synchronous cholecystectomy and fistula disconnection at the same stage, often pose a debate among surgeons. The decision for operative strategies largely depends on the surgeon's experience, patient's physiology, and operative difficulties. As literature on gall stone ileus remains insufficient at a regional level, we report four cases of gallstone ileus managed with different approaches. Three patients were managed in a staged-manner, whereas one patient received a definitive procedure performed at index surgery. Clinical challenges and associated operative strategies are discussed. Findings of the current study were compared to those of the literature. The need for a definitive fistula disconnection and repair or cholecystectomy following stone removal in these patients was subsequently discussed.

Dual Bowel Obstruction: A Rare Case of Gallstone Ileus and Colonic Adenocarcinoma

Bowel obstruction is a surgical emergency that leads to a high rate of admissions. Twenty percent of patients with acute abdominal pain will be diagnosed with bowel obstruction; eighty percent of them are of small origin. It is classified based on etiology to either mechanical or functional. Mechanical obstruction is a physical barrier that obstructs the passage of bowel content; it could be caused by adhesion, tumors, volvulus, hernias, strictures, and gallstone ileus. Functional obstruction is usually due to impaired peristalsis or metabolic disorders.

In this article, we report a case of an 80-year-old gentleman with no previous surgical history who was found to have a bowel obstruction. Diagnostic imaging and colonoscopy showed that his clinical presentation was due to gallstone ileus with cholecysto-enteric fistula and sigmoid mass. He underwent exploratory laparotomy with small bowel resection and sigmoidectomy with primary anastomosis and diverting ileostomy. The final pathology showed early moderately differentiated polyp adenocarcinoma T1N0 and was kept on surveillance.

The novelty of this case is the presentation of two different abdominal pathologies, which lead to large and small bowel obstruction. Thus, the management decision was challenging, and a thorough workup is advisable in such cases.

Gallstone ileus: An unusual cause of intestinal obstruction

Gallstone ileus is an infrequent cause of intestinal obstruction. It is typically the result of cholecystoduodenal fistula, computed tomography scan is the best modality for the diagnosis. Surgical removal of the gallstone is the pillar of treatment to relieve intestinal obstruction. We report the case of a 77-year-old male with features of a small bowel obstruction. Computed tomography scan of the abdomen showed pneumobilia, a cholecystoduodenal fistula, and small bowel obstruction features suspicious for gallstone ileus. The patient had a laparotomy and removal of two gallstones via an enterotomy without postoperative complications.

Gallstone Ileus: An Improbable Cause of Mechanical Small Bowel Obstruction

Gallstone ileus (GI) is a rare complication of cholelithiasis and a rare cause of small bowel obstruction. It usually affects elderly women and the symptoms are nonspecific, both contributing to a delay in diagnosis and a high mortality rate. It is necessary to have a high suspicion index for diagnosis and abdominal CT is the gold standard imaging for the diagnosis. We present a case report of an 87-year-old man who presented to the ED with abdominal pain and vomiting for the last 20 days. A GI was diagnosed and he underwent enterolithotomy to remove the stone. Unfortunately, the patient died on the 13th postoperative day with multiorgan failure. The treatment and the time at which it is performed must be adapted to each patient.

Gallstone Ileus: An Unusual Cause of Intestinal Obstruction

Gallstone ileus is an uncommon complication of gallstones and a rare cause of intestinal obstruction. Typically as a result of the formation of cholecystoduodenal fistula, surgical removal of the gallstone is the mainstay of treatment in order to relieve the intestinal obstruction. A 34-year-old male with no history of cholelithiasis presented with features of a small bowel obstruction. CT scan of the abdomen demonstrated pneumobilia, a cholecystoduodenal fistula and small bowel obstruction, features suspicious for a gallstone ileus. The patient underwent a laparotomy and removal of two gallstones via an enterotomy. He was discharged home after an uneventful post-operative period. Gallstone ileus is an uncommon cause of mechanical bowel obstruction with often delayed presentation and non-specific symptoms. A high level of suspicion is required in at-risk groups, and in patients presenting with a bowel obstruction and known gallstone disease.