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

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.

Gall stone ileus in the absence of gall bladder: a case report

Post cholecystectomy gall stone ileus is very rare with only few cases reported in the literature. This condition poses diagnostic challenges both because of its rarity and since the gall bladder had been removed previously. A high index of suspicion is needed for the diagnosis. Here, we report the case of a young female presented to the emergency room with acute intestinal obstruction. Patient underwent cholecystectomy followed by LSCS 20 yrs back. Patient was managed with explorative laparotomy which revealed an adherent, fibrosed and narrow segment of ileum containing a small impacted gall stone 120 cm from ileocaecal junction. Following the Resection anastomosis the patient made a satisfactory recovery and was discharged without any complication and is doing well.

Presentation of Gall Stone Ileus as Gut Obstruction

Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case report, we discuss a difficult diagnostic case of gallstone ileus presenting as small gut obstruction with ischemia. A 56-year-old female presented with abdominal pain and vomiting. A CT scan was performed and showed an evolving bowel obstruction with features of gut ischemia with pneumobilia although no frank hyper density suggestive of a gallstone was noted. The patient underwent emergency surgery and a 60 mm obstructing calculus was removed from the patient's jejunum, with a formal tube cholecystostomy. JMS 2018: 21 (2):117-119

Gall stone ileus- a rare cause of intestinal obstruction: a case report and review of literature

Gall stone ileus is an uncommon and potentially serious complication of cholelithiasis. The formation of fistula between the gallbladder and duodenum may allow the gallstone to enter the intestinal tract. It carries a significant morbidity and mortality due to the advanced age of patients and high incidence of concomitant diseases. Here we report a case of a 75-year-old male patient who is a known diabetic, hypertensive and COPD with a recent history of surgery for obstructed umbilical hernia. He presented in the emergency department with small bowel obstruction owing to a large stone in ileum. The clinical presentation, radiological features, operative procedure and literature review are presented.