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].
Keywords: Cholelithiasis, gallstone ileus, small bowel
obstruction