An emergency case of small bowel obstruction due to multiple gallstones in a limited resource setting

Abstract

HighlightsGallstone ileus is a rare condition accounting for 5% of all intestinal obstruction cases in which the mortality rate is relatively high (25%).Preoperative diagnosis is a major challenge because the symptoms are unspecific and diagnosis is often established intraoperatively.Surgical treatment with enterolithotomy alone is recommended for geriatric patients with concomitant comorbidities.Enterolithotomy alone might also be suitable in the case of emergency because of less clinical complications and comparable outcomes.

Spontaneous resolution of gallstone ileus followed by imaging: A case report and a literature review

“…ABXR is usually the front-line tool used in an emergency setting in cases of abdominal obstruction. In cases of GI, it is possible to research 3 typical signs also known as Rigler's triad [ 1 , 3 , 5 , 8 , 9 , 13 ]. These signs increase the specificity of the pathology and point us toward the diagnosis of GI.…”

“…Contrast-enhanced CT is the modality of choice in the emergency setting for the diagnosis of acute abdomen because of its speed and for the panoramic view through the multiplanar reconstruction. CT has a higher sensitivity and also a high specificity, accounting for 93% and 100%, respectively [ 1 , 5 , 8 , 9 , 13 ]. It is usually very accurate in the diagnosis of GI because it provides information on gallbladder abnormalities, the fistulous tract, the gallstone location, and the grade of the intestinal obstruction.…”

Two Sites of Obstruction with Gallstones: A Case Report of Bouveret Syndrome with a Concurrent Biliary Ileus

“…However, 25% of intestinal obstructions in patients older than 65 years are attributable to gallstones [2,3,8,14,15]. Multiple stones may be retrieved in the digestive tract [5][6][7], and recurrence is reported between 2% and 8% [2,3,8]. Nearly, half of the episodes of recurrence occur within one month [2,3,6], and recurrence in the immediate postoperative period has also been reported [4,8,[14][15][16].…”

“…Cholecystectomy and closure of the duodenal fistula were not planned as in one-stage surgery [6]. The procedure would have been time-consuming and technically challenging [2,4,5], considering the inflammation and the encountered adhesions. Besides, an absence of any retained gallstone in the gallbladder also advocated against the option of cholecystectomy and fistula closure [20].…”

“…Biliary ileus, also known as gallstone ileus, refers to an impacted gallstone within the lumen of the bowel causing obstruction [2][3][4]. Multiple stones may be retrieved in the digestive tract [5][6][7], but recurrence is uncommon [2,3,8]. Nevertheless, simultaneous dual-site obstruction is very rare [9][10][11][12], with only two earlier reported cases involving Bouveret syndrome in the literature [7,13].…”