Gallstone Ileus: An Improbable Cause of Mechanical Small Bowel Obstruction

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Gallstone ileus presenting as small bowel obstruction: spiral CT evaluation

Emergency Radiology ◽

10.1007/s101400050046 ◽

1999 ◽

Vol 6 (3) ◽

pp. 170-172 ◽

Cited By ~ 2

Author(s):

Harpreet K. Pannu ◽

E. K. Fishman

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Gallstone Ileus ◽

Spiral Ct ◽

Ct Evaluation

Download Full-text

Radiolucent gallstone ileus masquerading as closed loop small bowel obstruction

ANZ Journal of Surgery ◽

10.1111/ans.16144 ◽

2020 ◽

Author(s):

Shaneel Bappayya ◽

Hao‐Hsuan Tsai ◽

Neil Jayasuriya

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Closed Loop ◽

Gallstone Ileus

Download Full-text

Recurrent small bowel obstruction after laparoscopic surgery for gallstone ileus

Surgical Endoscopy ◽

10.1007/s00464-003-4213-1 ◽

2003 ◽

Vol 17 (10) ◽

pp. 1679-1679 ◽

Cited By ~ 5

Author(s):

R. Hagger ◽

S. Sadek ◽

K. Singh

Keyword(s):

Laparoscopic Surgery ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Gallstone Ileus

Download Full-text

Small-bowel obstruction after modified jejunoileal bypass surgery due to gallstone ileus

Journal of Research in Medical Sciences ◽

10.4103/jrms.jrms_1060_18 ◽

2019 ◽

Vol 24 (1) ◽

pp. 54

Author(s):

Abdolreza Pazouki ◽

Mohammad Kermansaravi ◽

Samaneh Rokhgireh ◽

AmirHosein Davarpanah Jazi

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Bypass Surgery ◽

Gallstone Ileus ◽

Jejunoileal Bypass

Download Full-text

A wandering tube

CJEM ◽

10.1017/cem.2016.393 ◽

2016 ◽

Vol 19 (5) ◽

pp. 398-399

Author(s):

Ina Dubin ◽

Moshe Gelber ◽

Ami Schattner

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Geriatric Patients ◽

Gallstone Ileus ◽

Age Groups ◽

Gastrostomy Tube ◽

Emergency Physicians ◽

Adult Age

ABSTRACTThe predominant causes of acute mechanical small bowel obstruction in geriatric patients are adhesions and hernias, which is not much different than in other adult age groups. Unusual etiologies may be encountered, such as volvulus or gallstone ileus, but a displaced feeding gastrostomy tube is a distinctly rare cause of intestinal obstruction which needs to be considered by emergency physicians as it may be increasingly encountered.

Download Full-text

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

BJR|case reports ◽

10.1259/bjrcr.20200207 ◽

2021 ◽

pp. 20200207

Author(s):

Nisham Ghimire ◽

Diogo JV Silva ◽

Akshay Bavikatte ◽

Mojolaoluwa Olugbemi ◽

Ami Mishra ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Gallstone Ileus ◽

Cholecystoduodenal Fistula ◽

Elderly Male ◽

Unique Case ◽

Inguinoscrotal Hernia ◽

Common Causes ◽

Rare Diagnosis

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.

Download Full-text