IDDF2018-ABS-0012 Gallstone ileus: a case report on a 30-year-old young patient and literature review

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Abstract

Background

Gallstone ileus is a rare cause of intestinal obstruction (1%–4% of all cases of bowel obstruction). It affects mainly the older population with a female preponderance. A 30-year-old woman presented to the emergency room with clinical signs of intermittent intestinal obstruction. Diagnostic imaging revealed obstruction of the terminal ileum caused by a 25 mm calculus. The patient completely recovered after urgent surgery. This condition is very rare and more so in a young patient.

Methods

A 30-year-old female presented with intermittent vomiting and abdominal pain for 7 days. She had a history of episodic epigastric pain for the last one year and a half.

Methods

Physical examination showed a moderately distended abdomen, tympanitic and hypoactive sounds. Rectal examination was normal. Pertinent ancillary tests were done with the following results:

Methods

Whole abdominal CT scan showed pneumobilia and adhesions in the gallbladder wall and duodenal wall, dilated small bowels and an ovoid calcific density with internal hypodensity in the small intestine lumen. The result of which is consistent with the RIGLER TRIAD seen in gallstone ileus.

Results

The patient underwent immediate exploratory laparotomy. Intraoperative findings revealed an impacted gallstone measuring 10 cm in widest diameter located at the terminal ileum (40 cm from the ileocecal valve) causing complete bowel obstruction on the proximal part of the ileum and jejunum. The gallbladder was inspected, and a stable cholecysto-enteric fistula was noted. An enterotomy was made on the proximal non-dilated part of the ileum and revealed a large gallstone (10 × 4.5 × 3 cm). There was difficulty in extracting the stone, so a segmental resection of the involved ileum was done. A 2-layer end-to-end anastomosis was done using silk 3.0.

Results

The postoperative course was uneventful and was discharged improved on postoperative day 4 (hospital day 10).

Conclusions

In conclusion, the choice of the surgical procedure is largely determined by the clinical condition of the patient. The single-stage procedure is performed in haemodynamically-stable patients, while enterolithotomy alone is considered sufficient for unstable patients with metabolic derangements.

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