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.

Spontaneous cholecystoduodenal fistula - spectrum of complications

“…Migrating through the fistula, large gallstones could cause intestinal obstruction, but they could also migrate to any part of the gastrointestinal tract without causing any symptoms. The most commonly obstructed part is the terminal ileum, which leads to the gallstone ileus [2,4,10]. Classic abdominal radiographic signs of pneumobilia, mechanical bowel obstruction, and ectopic gallstone were first described by Rigler, but in around one half of the patients there are usually two out of three signs [1,3,11].…”

“…Душан Шапоњски 1 , Александра Ђурић-Стефановић 1,2 , Александра Јанковић 1 , Милица Митровић-Јовановић 1 , Стефан Кмезић 3 , Слађана Михајловић 2,4 , Иван Поповић 5 , Ђорђије Шарановић 6,7 1 Клинички центар Србије, Прва хируршка клиника, Центар за радиологију и магнетну резонанцу, Одељење дигестивне радиологије, Београд, Србија; 2 Универзитет у Београду, Медицински факултет, Београд, Србија; 3 Клинички центар Србије, Прва хируршка клиника, Београд, Србија; 4 Клиничко-болнички центар "Др Драгиша Мишовић -Дедиње", Београд, Србија; 5 Општа болница "Стефан Високи", Смедеревска Паланка, Србија; 6 Општа болница "Медигруп", Београд, Србија; 7 Универзитет у Бањој Луци, Медицински факултет, Бања Лука, Република Српска, Босна и Херцеговина…”

“…This entity is more common in the elderly and is manifested with a number of nonspecific signs and symptoms. The pathognomonic triad (Rigler triad) of pneumobilia, small-bowel distention, and ectopic gallstones on conventional abdominal radiographs is seen in 30-35% of all cases with gallstone ileus [1][2][3][4][5]. Duodenal obstruction caused by an ectopic gallstone happens in only 1-3% of the patients and is known as the Bouveret syndrome [1,6,7].The rarest complication is a floating non-obstructing gallstone trapped in the stomach, which can also lead to gastric outlet, persistent emesis, and esophageal rupture (Boerhaave syndrome), as reported in the study by Modi et al [8].…”

Gallstones Ileus

“…These authors found that this sign was present in 24% of patients at the time of hospitalization. In Bouveret's syndrome, a dilated stomach is expected to be seen on a simple abdominal radiograph due to gastric obstruction [37,42,43,[46][47][48][49]. Cappell et al [31], in a review of 64 cases of Bouveret syndrome, found pneumobilia (39%), calcified upper right quadrant mass or gallstones (38%), and gastric distension (23%) as relatively common findings and dilated loops of the intestine (14%).…”

Gallstone Ileus with associated perforated small bowel diverticulitis

“…Gallstone ileus is more common in the elderly and up to 80% -90% of affected patients have medical comorbidities [2]. The ratio of occurrence in females to males is 3.5:1 [3].…”