Gallstone Ileus with associated perforated small bowel diverticulitis

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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1074 Gallstone Ileus: Two Decades After Cholecystectomy

British Journal of Surgery ◽

10.1093/bjs/znab259.358 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

K Matwala ◽

M R Iqbal ◽

T Shakir ◽

D W Chicken

Keyword(s):

Small Bowel ◽

Bowel Obstruction ◽

Rare Complication ◽

Open Cholecystectomy ◽

Gallstone Ileus ◽

Proximal Small Bowel ◽

Solid Diet ◽

History Of ◽

Ileocaecal Junction ◽

Tomography Scan

Abstract Introduction Gallstone ileus is a rare complication of gallstones that occurs in 1%-4% of all cases of bowel obstruction. We present a surprising case of gallstone ileus causing small bowel obstruction 19 years after open cholecystectomy. Case Report A 77-year-old male presented with a 3-day history of abdominal pain, 4 episodes of vomiting and absolute constipation. He had a surgical background of an open cholecystectomy and open appendicectomy 19 years and 45 years ago respectively. Medically, he had well-controlled hypertension and experienced a TIA 5 years prior. Computed Tomography Scan of the abdomen and pelvis revealed features consistent with an obstructing, heterogenous opacity in the distal small bowel without pneumobilia. The patient subsequently underwent diagnostic laparoscopy. Intraoperatively, an obstructing gallstone, measuring 4 cm, was found 50cm proximal to the ileocaecal junction, with dilatation of the proximal small bowel and distal collapse. Enterotomy and removal of the stone was done. Post-operatively, this gentleman recovered without complications and was discharged home two days later after being able to tolerate a solid diet. Conclusions This is the second reported case of gallstone ileus in a patient with previous cholecystectomy about two decades ago, according to our literature search. Although extremely rare, absence of the gallbladder does not exclude the possibility of gallstone ileus.

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Gallstone ileus in an ‘asymptomatic’ parastomal hernia

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0173 ◽

2016 ◽

Vol 98 (7) ◽

pp. e121-e122

Author(s):

H Jayamanne ◽

J Brown ◽

BM Stephenson

Keyword(s):

Computed Tomography ◽

Small Bowel ◽

Parastomal Hernia ◽

Gallstone Ileus

Parastomal hernias are common and often asymptomatic. We report the first known case in which later, acute symptoms developed owing to gallstone ileus in a sac containing both omentum and small bowel. Urgent computed tomography established the diagnosis.

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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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Tríada de Rigler radiológica en un caso de íleo biliar

Revista Argentina de Cirugía ◽

10.25132/raac.v112.n2.1469.es ◽

2020 ◽

Vol 112 (2) ◽

pp. 203-204

Author(s):

Martín Varela Vega ◽

◽

Micaela Mandacen ◽

Andrés Pouy

Keyword(s):

Gastrointestinal Tract ◽

Small Bowel ◽

Rare Complication ◽

Gallstone Ileus ◽

Mechanical Obstruction ◽

Cholecystoduodenal Fistula ◽

Radiographic Evidence ◽

Rigler’S Triad

Background: gallstone ileus is a rare complication of cholelithiasis. It is defined as a mechanical obstruction of the small bowel due to impaction of large gallstones into the gastrointestinal tract, generally though a cholecystoduodenal fistula. Rigler’s triad (pneumobilia, ectopic gallstone and mechanical obstruction) occurs in 30% of the patients. Surgery is indicated and includes enterotomy with gallstone extraction. Objective: we report a case of gallstone ileus with radiographic evidence of Rigler’s triad

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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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Technical Approach to Laparoscopic Examination of the Small Bowel in Gallstone Ileus

Case Reports in Surgery ◽

10.1155/2020/8852804 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Sarah Assali ◽

John Mourany ◽

Brendan Jones ◽

Lauren Dudas ◽

Nova Szoka

Keyword(s):

Small Bowel ◽

Case Reports ◽

Gallstone Ileus ◽

Laparoscopic Approach ◽

The Elderly ◽

Acute Care Surgery ◽

Technical Approach ◽

Entire Small Bowel ◽

Feasible Option ◽

Care Surgery

Background. Gallstone ileus is an infrequent cause of small bowel obstructions (SBO), accounting for only 0.1-5% of SBOs and 25% of nonstrangulating causes of SBO in the elderly population. There is scant literature available regarding the use of laparoscopy to treat gallstone ileus. Currently, much of the literature available is limited to case reports only. Methods. A complete laparoscopic approach was utilized to manage a 65-year-old woman with morbid obesity who presented with gallstone ileus. With regard to our technical approach, we describe the technical approach that facilitates safe laparoscopic examination of the entire small bowel and can be applied to other acute care surgery cases involving small bowel pathology. Results. The patient’s postoperative course was complicated by new-onset atrial fibrillation which was treated medically with good response. She was safely discharged on postoperative day 2. Conclusion. Laparoscopy is a feasible option for the management of gallstone ileus and can lead to decreased morbidity compared to laparotomy. The technique described allows for laparoscopic examination of the entire small bowel.

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