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Matli VVK, Marler KC, Morgan A, Pujala V, Pandit S, Morris J. Gallstone Enteropathy: An Unusual Cause of Bowel Obstruction. Cureus 2023; 15:e44707. [PMID: 37809230 PMCID: PMC10552588 DOI: 10.7759/cureus.44707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Gallstones causing bowel obstruction, known as gallstone ileus, are rare and account for less than 0.5% of small bowel obstruction cases. Additionally, it is a rare complication affecting only 0.3% of patients who have gallstones. Fistula formation between the biliary system, most commonly between the gallbladder and duodenum because of their proximity, facilitates the migration of gallstones into the enteric system with subsequent impaction in the small intestine, usually in the distal ileum close to the ileocecal valve, promoting the development of mechanical small bowel obstruction. Computerized tomography of the abdomen and pelvis is a confirmatory and widely used imaging study when there are two signs of Rigler's triad, which includes pneumobilia, evidence of small bowel obstruction and the presence of radiopaque stones. We report a case of a 75-year-old Caucasian man who presented with abdominal distention with signs of severe dehydration secondary to intractable nausea and vomiting complicated with severe acute kidney injury and was found to have a 4.7-centimeter gallstone-induced small intestinal obstruction.
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Affiliation(s)
| | - Kevin C Marler
- General Surgery, Christus Highland Medical Center, Shreveport, USA
| | - Andre Morgan
- Internal Medicine, Christus Highland Medical Center, Shreveport, USA
| | - Varsha Pujala
- Internal Medicine, Christus Highland Medical Center, Shreveport, USA
| | - Sudha Pandit
- Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - James Morris
- Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Shreveport, USA
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Jakubauskas M, Luksaite R, Sileikis A, Strupas K, Poskus T. Gallstone Ileus: Management and Clinical Outcomes. ACTA ACUST UNITED AC 2019; 55:medicina55090598. [PMID: 31533295 PMCID: PMC6780297 DOI: 10.3390/medicina55090598] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/05/2019] [Accepted: 09/15/2019] [Indexed: 01/08/2023]
Abstract
Background: Gallstone or biliary ileus is a late complication of gallstone disease. It accounts for 1%–4% of all bowel obstructions and is more common in elderly patients. The preferred treatment option is to mechanically remove the impacted stones. It is done surgically using open or laparoscopic approach and rarely, when stones are impacted in the colon, endoscopically. In this paper we present five consecutive cases of gallstone ileus and describe possible diagnostic and minimally invasive treatment options. Case presentation: During a five-month period a total of five patients were treated for gallstone ileus. All patients were female and from 48 to 87 years of age. Symptoms were not specific and common for all small bowel obstructions. Upon admission the patients also had unspecific laboratory findings—neutrophilic leukocytosis and various C-reactive protein concentrations, ranging from 8 to 347 mg/L. According to the hospital protocol, all patients initially underwent an abdominal ultrasound, which was inconclusive, and therefore every patient additionally had a CT scan with intravenous contrast. After these two diagnostic modalities one patient still did not have the definitive gallstone ileus diagnosis, as the ectopic stone was not visible. Four patients in our case series were treated using minimally invasive methods: in one case the stone was removed endoscopically, and laparoscopically in the other three. Treatment outcomes were good in four cases as the patients fully recovered, however one patient suffered a massive cerebral infarction after the operation and passed away. Conclusions: Gallstone ileus is a rare and difficult-to-diagnose condition. Management of these patients in every case should be individualized, as there are many options, each with their own advantages and disadvantages. We show that minimally invasive treatment such as colonoscopy or laparoscopy is possible in these cases.
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Affiliation(s)
- Matas Jakubauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Center of Abdominal Surgery, Vilnius University Hospital "Santaros Klinikos", 08410 Vilnius, Lithuania
| | - Raminta Luksaite
- Department of Radiology, Nuclear Medicine and Physics of Medicine, Center for Radiology and Nuclear Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Center of Radiology and Nuclear Medicine, Vilnius University Hospital "Santaros Klinikos", 08410 Vilnius, Lithuania
| | - Audrius Sileikis
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Center of Abdominal Surgery, Vilnius University Hospital "Santaros Klinikos", 08410 Vilnius, Lithuania
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Center of Abdominal Surgery, Vilnius University Hospital "Santaros Klinikos", 08410 Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania.
- Center of Abdominal Surgery, Vilnius University Hospital "Santaros Klinikos", 08410 Vilnius, Lithuania.
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