Gallstone ileus presenting as small bowel obstruction: spiral CT evaluation

Abstract Introduction Small bowel obstruction can be caused by multiple factors. We describe an unusual case of small bowel obstruction secondary to three rare factors: gallstone ileus, peritoneal encapsulation and congenital adhesional band. Case Presentation A seventy-nine-year-old male presented with a four-day history of obstipation and abdominal pain. CT abdomen pelvis revealed small bowel obstruction secondary to gallstone ileus. The patient was managed by laparotomy. The intraoperative findings revealed the presence of a congenital peritoneal encapsulation with an adhesional band and gallstone proximal to the ileo-caecal valve. Although there was some dusky small bowel, this recovered following the release of the band. Discussion Peritoneal Encapsulation is a rare congenital pathology resulting in the formation of an accessory peritoneal membrane around the small bowel. This condition is asymptomatic and rarely presents as small bowel obstruction. The diagnosis is often made at laparotomy. There are less than 60 cases reported in literature. Gallstone ileus is another rare entity caused by an inflamed gallbladder adhering to part of the bowel resulting in a fistula. Conclusions The rarity of these conditions mean that they are poorly understood. A combination of this triad of gall stone ileus in the presence of peritoneal encapsulation and congenital band has not been reported before. Knowledge of this would raise awareness, facilitate diagnosis and management of patients.

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CT Evaluation of Small Bowel Obstruction

Radiographics ◽

10.1148/radiographics.21.3.g01ma03613 ◽

2001 ◽

Vol 21 (3) ◽

pp. 613-624 ◽

Cited By ~ 106

Author(s):

Mourad Boudiaf ◽

Philippe Soyer ◽

Carine Terem ◽

Jean Pierre Pelage ◽

Emmanuelle Maissiat ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Ct Evaluation

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Gallstone Ileus: An Unlikely Cause of Mechanical Small Bowel Obstruction

Case Reports in Gastroenterology ◽

10.1159/000475749 ◽

2017 ◽

Vol 11 (2) ◽

pp. 389-395 ◽

Cited By ~ 3

Author(s):

Estela Abich ◽

Daniel Glotzer ◽

Edward Murphy

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Gallstone Ileus ◽

Abdominal Distension ◽

Acute Onset ◽

Female Population ◽

Coffee Ground ◽

Intestinal Obstructions ◽

Emergent Laparotomy

Gallstone ileus is a rare disease that accounts for 1–4% of intestinal obstructions. Almost exclusively a condition in the older female population, it is a difficult diagnosis to make. We report the case of gallstone ileus in a 94-year-old Caucasian female, who presented to the emergency department with acute-onset nausea, coffee-ground emesis, lack of bowel movement, and abdominal distension. On CT scan, the diagnosis of gallstone ileus was made by the presence of a cholecystoduodenal fistula, pneumobilia, and small bowel obstruction. Emergent laparotomy with a one-stage procedure of enterolithotomy and stone removal by milking the bowel distal to the stone were performed. The postoperative course was uneventful until postoperative day 4 when the patient was found tachycardic, lethargic, and unresponsive. We reviewed the literature on the diagnosis and treatment of gallstone ileus.

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Gallstone Ileus: An Improbable Cause of Mechanical Small Bowel Obstruction

Cureus ◽

10.7759/cureus.11460 ◽

2020 ◽

Author(s):

Sara Lourenço ◽

Ana Marta Pereira ◽

Jose Reis ◽

Marta Guimarães ◽

Mário Nora

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Gallstone Ileus

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Gallstone Ileus Decades after Cholecystectomy and Pylorus-Preserving Whipples

Case Reports in Surgery ◽

10.1155/2020/8866254 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Miho Mugino ◽

Takako Eva Yabe ◽

Bruce Ashford

Keyword(s):

Computed Tomography ◽

Small Bowel ◽

Literature Review ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Transition Point ◽

Gallstone Ileus ◽

Whipple Procedure ◽

Stone Analysis ◽

Intraluminal Mass

We report a case of small bowel obstruction due to gallstone ileus found in a patient with previous pancreaticoduodenectomy (Whipple procedure). Investigation by computed tomography of the abdomen showed a transition point in the midjejunum due to a radioopaque intraluminal mass. Following resuscitation, the patient underwent laparotomy to remove the offending mass from the midjejunum. Subsequent stone analysis confirmed a cholesterol-rich gallstone. This is thus the first description of gallstone ileus following Whipple procedure. The rarity of this presentation and a literature review is presented.

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Bile Salt Enterolith: An Unusual Etiology Mimicking Gallstone Ileus

Case Reports in Surgery ◽

10.1155/2018/8965930 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Dana Ferrari-Light ◽

Ariel Shuchleib ◽

Joel Ricci-Gorbea

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Surgical Intervention ◽

Gallstone Ileus ◽

Duodenal Diverticulum ◽

Multiple Risk Factors ◽

History Of ◽

High Index Of Suspicion ◽

Distal Jejunum

Primary enterolithiasis is a relatively uncommon but important cause of small bowel obstruction. We present a case of a 69-year-old male with a history of laparoscopic Roux-en-Y gastric bypass and asymptomatic duodenal diverticulum diagnosed with small bowel obstruction. CT imaging showed an obstruction distal to the jejunojejunostomy, and surgical intervention was warranted. A 4.5 cm enterolith removed from the distal jejunum was found to contain 100% bile salts, consistent with a primary enterolith. Clinicians should retain a high index of suspicion for enteroliths as a cause of small bowel obstruction, especially if multiple risk factors for enterolith formation are present.

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