Bowel obstruction secondary to gallstone ileus within an inguinoscrotal hernia: a rare diagnosis in an elderly patient

Gallstone ileus and obstructed inguinal hernias are respectively, rare and common causes of small bowel obstruction. There are no published cases of these pathologies occurring simultaneously. Here, we describe a unique case of an elderly male patient presenting with a small bowel obstruction caused by these combined pathologies. Following an acute presentation with obstructive symptoms, a CT scan demonstrated small bowel obstruction due to a large gallstone lodged in the neck of an inguinoscrotal hernia with associated pneumobilia. The case may have been managed conservatively if it was not for the presence of the gallstone. Previous imaging had incidentally demonstrated gallstones in the gallbladder and a large uncomplicated right inguinoscrotal hernia. It is presumed that a cholecystoduodenal fistula formed and a gallstone then migrated downstream to lodge within the neck of the inguinoscrotal hernia. This case underscores the concept that even in the presence of an “obvious” cause of small bowel obstruction, such as an irreducible, large inguinoscrotal hernia, we must always maintain a healthy clinical skepticism and an open mind to other unexpected aetiologies, which may account for the clinical presentation that might impact subsequent management.

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563 A Rare Case of Small Bowel Obstruction Secondary to Peritoneal Encapsulation, Congenital Adhesional Band and Gallstone Ileus

British Journal of Surgery ◽

10.1093/bjs/znab259.300 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P Gungadin ◽

A Taib ◽

M Ahmed ◽

A Sultana

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Unusual Case ◽

Gallstone Ileus ◽

Gall Stone ◽

Case Presentation ◽

Peritoneal Encapsulation ◽

History Of ◽

Gall Stone Ileus

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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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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EP.TU.193Omental band - A unusual cause of mechanical small bowel obstruction in a virgin abdomen

British Journal of Surgery ◽

10.1093/bjs/znab311.025 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Santhosh Loganathan ◽

Adam O'Connor ◽

Amal Singh ◽

Mazyar Fani

Keyword(s):

Small Bowel ◽

Abdominal Surgery ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Closed Loop ◽

White Blood Cells ◽

Serum Lactate ◽

Proximal Small Bowel ◽

Constriction Band ◽

Common Causes

Abstract Introduction The small bowel obstruction in a non-operated abdomen is rare, and the most common causes are hernia and neoplasm. The complete mechanical small bowel obstruction due to an omental band in a patient with no previous abdominal surgery is rare, and less than five cases have been reported in the literature. Case presentation We report a 65 year old male patient presented to the emergency department with complaints of abdominal pain, distension, vomiting and obstipation for four days. On clinical examination, his abdomen was distended, diffusely tender, guarding. The blood investigations showed elevated White blood cells and neutrophils with normal CRP and the Serum lactate. The Abdominal X-ray was suggestive of SBO. The Computed tomography of the abdomen and pelvis showed marked dilatation of the jejunum, the ileum is entirely collapsed, the impression of a double beak sign in the mid-abdomen which would suggest closed-loop obstruction due to a possible internal hernia. We proceeded with emergency diagnostic laparoscopy converted to laparotomy, which showed omental band causing closed-loop proximal small bowel obstruction. The bowel loops appeared congested with the constriction band due to omental band. The omental band was divided, and the obstruction was relieved. Postoperatively patient recovered well and was discharged on day three post-op. Discussion The timely diagnosis and intervention could prevent complications like strangulation, ischemia and gangrene. Though the omental band is rare, it should still be suspected as an aetiology in patients without prior abdominal surgery.

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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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When Diarrhea Can Become Deadly: Legionnaires’ Disease Complicated by Bowel Obstruction

Case Reports in Gastroenterology ◽

10.1159/000453657 ◽

2016 ◽

Vol 10 (3) ◽

pp. 781-786 ◽

Cited By ~ 3

Author(s):

Wesley Prichard ◽

Laurel Fick

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Broad Spectrum ◽

Unique Case ◽

Legionnaires Disease

Legionnaires’ disease may present with a broad spectrum of illnesses and nonspecific extrapulmonary symptoms including diarrhea. To our knowledge, bowel obstruction has not been reported as a manifestation of Legionella. We present a unique case of Legionnaires’ disease contributing to a small bowel obstruction.

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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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