Gall stone ileus: Unfamiliar cause of bowel obstruction. Case report and literature review

Abstract

HighlightsTo highlight a forgotten cause of bowel occlusion due to cholecystoduodenal fistula.Importance of knowledge of this rare entity and its clinical manifestation.Familiarity of its radiological findings can lead to early diagnosis and better outcome.Choice of surgical option must be tailored according to patient's medical condition.

Gallstone Ileus: An Unusual Cause of Intestinal Obstruction

“…While there is consensus regarding the need for enterolithotomy, there is controversy in the literature as to whether a cholecystectomy and fistula repair should be performed concurrently. Of the two procedures, there is a known increased risk of morbidity and mortality associated with a single-stage procedure; however, there is also the risk of further complications from gallstones while awaiting a cholecystectomy and repair of fistula in a two-staged procedure [2][3][4][5][6]9]. Intraoperatively, our patient was noted to have a chronically inflamed and contracted gallbladder with a large fistula tract.…”

“…Most stones lodge in the ileum (60.5%), the narrowest segment of the bowel; reduced peristalsis in this area has also been suggested to be a contributing factor. Stones may also lodge in the jejunum (16.1%), stomach (14.2%) and less commonly the duodenum (3.5%) [1,2,4,6]. Most reported cases of obstruction demonstrate a gallstone larger than 2 cm in diameter, with smaller stones potentially able to pass through the intestine to the rectum [2][3][4]7,8].…”

Íleo biliar en adulto joven. Reporte de un caso

“…El tratamiento quirúrgico se realiza como resultado del diagnóstico preoperatorio o por hallazgo intraoperatorio (12) , su objetivo principal es el alivio inmediato de la obstrucción intestinal al eliminar el cálculo biliar (20) ; en el caso relatado el primer tiempo quirúrgico incluyó, entre otros, enterotomía para extracción del cálculo y colecistectomía.…”

Surgical Recovery of Intestinal Obstructions: Pre- and Postoperative Care and How Could it Be Prevented?

“…It should not be forgotten that obstructions proximal to the small intestine may be overlooked as they may not be able to produce air-fluid level on the radiograph. Nevertheless, it is still used as the cheapest, most practical, and easiest diagnostic method in appropriate patients [3,10,11].…”

“…Hematoma in the small intestinal wall, tumor, and invagination can also be observed if obstruction is due to an intramural cause. Gallstones, bezoars, and foreign bodies, which are among the intraluminal causes, can also be easily observed by computed tomography [10][11][12]. In laboratory tests, it should be kept in mind that the patient may be in a hemoconcentrated state following the intravascular volume decrease due to fluid loss to the third space.…”