Journal of Clinical Medicine
Gallstone Ileus Presenting as Small Bowel Obstruction in an Elderly Patient: Diagnostic Approach and Surgical Management
Par Yerkhanat Khuanbai, Berik Rovgaliyev, Tlek Karimov et 2 autres.
Contenu en anglais
Résumé
Background
Gallstone ileus is an uncommon cause of mechanical intestinal obstruction that predominantly affects older adults. It results from migration of a gallstone through a biliary–enteric fistula, most commonly a cholecystoduodenal fistula.
Methods
An 84-year-old woman with hypertension and hypothyroidism presented with a four-day history of right upper quadrant abdominal pain, nausea, and vomiting. Laboratory investigations showed a marked inflammatory response and severe renal dysfunction with a substantial reversible acute component, most likely related to volume depletion and reduced renal perfusion. Computed tomography demonstrated an ectopic gallstone impacted in the distal small bowel, proximal bowel dilatation, pneumobilia, and a cholecystoduodenal fistula. Emergency laparotomy confirmed gallstone ileus. After assessment of the operative risk and local anatomy, a one-stage procedure was performed, comprising enterolithotomy, cholecystectomy, division of the fistula, and primary repair of the duodenal defect.