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Gallstone ileus - a case report

Rozen Grigorov, Adrian Petkov, Teodor Kozhuharov, Plamen Chernopolski, Vasil Bozhkov


Introduction: A gallstone in the gallbladder may cause acute inflammation and eventually move into the adjacent duodenum through a cholecysto-enteric fistula. Regardless of the size of the stone, it can cause small bowel obstruction which is called gallstone ileus. It is a rare condition that accounts for one to four percent of intestinal obstructions.

Materials and methods: A 63-year-old female patient was admitted with a one-month history of left sided abdominal pain associated with vomiting and abdominal distention. X-ray and abdominal ul­trasound were performed and the following changes were discovered: dilated small bowel loops up to 42mm in the lower left abdominal quadrant with inflammatory changes and ascites. The patient un­derwent an emergency operation. Midline laparotomy was performed. Abundant quantity of intesti­nal content was found engaging all three floors of the abdominal cavity. A biliary calculus was found in the jejunum 50 cm from the ligament of Treitz. The stone was five cm in diameter, causing a total obstruction of the small intestine. There was a perforation of the bowel proximally from the concre­ment.

Results: 20 cm of the jejunum were resected during the surgery. The passage was restored via latero-lateral anastomosis. After a normal postoperative period without complications the patient was dis­charged on the 13th postoperative day in good general condition.

Conclusion: Gallstone ileus is a condition with high rates of mortality. In elderly patients presenting with symptoms of small bowel obstruction, gallstone ileus should be included in the differential diag­nosis. Surgical treatment is necessary once the diagnosis has been made.


gallstone; ileus; surgery; obstruction; abdomen



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