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\begin{document}

\title{Gallstone ileus: a rare cause of small intestine obstruction}



\author[1]{Levan Tchabashvili}%
\author[1]{Dimitris Kehagias}%
\author[1]{Charalampos Kaplanis}%
\author[1]{Elias Liolis}%
\author[1]{Ioannis Perdikaris}%
\author[1]{Fotis Iliopoulos}%
\author[1]{Georgios-Ioannis Verras}%
\author[1]{Francesk Mulita}%
\affil[1]{University General Hospital of Patras Holy Mary the Help}%


\vspace{-1em}



  
  \date{May 19, 2024}


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\selectlanguage{english}
\begin{abstract}
A 77-year-old woman was admitted to our emergency department complaining
of abdominal pain. Computed tomography was performed and showed
aerobilila and a large 5.1 cm gallstone lodged in the small intestine.
She underwent emergency surgery. Intraoperative findings noted small
bowel obstruction caused by a large gallstone.%
\end{abstract}%



\sloppy


\textbf{CLINICAL IMAGE}

\textbf{Gallstone ileus: a rare cause of small intestine obstruction}

\textbf{Levan Tchabashvili\textsuperscript{1}, Dimitrios
Kehagias\textsuperscript{1}, Charalampos Kaplanis\textsuperscript{1},
Elias Liolis\textsuperscript{2}, Ioannis Perdikaris\textsuperscript{1},
Fotios Iliopoulos\textsuperscript{1}, Georgios-Ioannis
Verras\textsuperscript{1}, Francesk Mulita\textsuperscript{1}}

\textsuperscript{1}Department of General Surgery, General University
Hospital of Patras, Greece

\textsuperscript{2}Department of Internal Medicine, General University
Hospital of Patras, Greece

Correspondence: Francesk Mulita MD, MSc, PhD(c), Resident Surgeon at the
Department of Surgery, General University Hospital of Patras, Achaia,
Greece, Tel.: +30 6982785142; E-mail:\emph{oknarfmulita@hotmail.com};
ORCID Id:\emph{https://orcid.org/0000-0001-7198-2628}

\textbf{Key Clinical Message}

Gallstone ileus is a very rare cause of mechanical bowel obstruction
with often-delayed presentation and non-specific symptoms. Aerobilia is
found in approximately 50\% of patients with gallstone ileus.

\textbf{Case Description}

A 77-year-old woman was admitted to our emergency department (ED)
complaining of abdominal distension, vomiting, and nausea. During
physical examination normal bowel sounds were auscultated, and there
were no signs of abdominal flatulence or tenderness. Her routine blood
tests were normal. However, her C reactive protein was elevated.
Abdominal x-rays revealed dilated small bowel as well as air-fluid
levels. A computed tomography (CT) was performed and showed aerobilila
and a large 5.1 cm gallstone lodged in the small intestine.~ The patient
was resuscitated with intravenous fluids and underwent emergency
surgery. Intraoperative findings noted small bowel obstruction with the
transition point at 70 cm from the ileocaecal valve caused by a large
gallstone obstructing the lumen (figure 1A). A longitudinal 3 cm
enterotomy was made proximal to the distal gallstone (figure 1B). The
stone was removed, and the enterotomy was closed transversely (figure
1C, D).

Gallstone ileus develops in less than 0.5\% of patients with
cholelithiasis and accounts for less than 5\% of non-strangulating
mechanical small bowel obstructions. Patients have non-specific
symptoms~and the diagnosis is often delayed since symptoms may be
intermittent and investigations may fail to identify the cause of the
obstruction. The majority of reported cases of obstruction demonstrate a
gallstone larger than 20 mm in diameter {[}1{]}. If~a clinician has a
clinical suspicion of gallstone ileus but the patient has negative
radiograph findings, a computed tomography (CT) scan should be
performed.~ Aerobilia is found in approximately 50\% of patients
{[}2{]}.

\textbf{Keywords:} Cholelithiasis, gallstone ileus, small bowel
obstruction

\textbf{Patient consent for publication}

A written informed consent was obtained from the patient for publication
of this case report.

\textbf{Conflict of interest}

There are no conflicts of interest to declare.

\textbf{Financial support and sponsorship}

None

\textbf{Author contribution}

FM, DK, LT, G-IV, IP, FI, CK, and EL: contributed to the clinical data
collection and prepared the case report. FM, LT and EL: contributed to
the design of the case report presentation and performed the final
revision of the manuscript.

\textbf{Data availability}

Data available on request from the authors

\textbf{References}

Morosin T, De Robles MSB, Putnis S. Gallstone Ileus: An Unusual Cause of
Intestinal Obstruction. Cureus. 2020 Mar 15;12(3):e7284.

Salazar-Jim\selectlanguage{ngerman}énez MI, Alvarado-Durán J, Fermín-Contreras MR, Rivero-Yáñez
F, Lupian-Angulo AI, Herrera-González A. Íleo biliar, revisión del
manejo quirúrgico {[}Gallstone ileus, surgical management review{]}. Cir
Cir. 2018;86(2):182-186. Spanish.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\textbf{Figure 1:} (A) Impacted gallstone. (B, C) Small bowel enterotomy
for removal of the impacted gallstone. (D) The enterotomy was closed
transversely\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

\end{center}
\end{figure}

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