Daniela Lira (Aveiro / PT), Alice Pimentel (Aveiro / PT), Sofia Dias da Silva (Aveiro / PT), Ana Moreira (Aveiro / PT), Maria Reigota Miranda (Aveiro / PT), Maria Costa (Aveiro / PT), José Baião (Aveiro / PT), Júlio Alves (Aveiro / PT), Joana Noronha (Aveiro / PT)
Abstract text (incl. references and figure legends)
A 47-year-old obese female patient presented to the emergency department with colicky epigastric pain and vomiting since the day before, without further changes in bowel habits. She had an episode of gallstone pancreatitis 9 years earlier with follow-up loss due to missed appointments. She had no previous abdominal surgery.
The patient had no fever or other abnormal vital signs on physical examination but abdominal epigastric tenderness without guarding or rebound tenderness.
Blood tests demonstrated leukocytosis and abdominal radiography showed pneumobilia and signs of small bowel obstruction (figure 1). CT scan revealed intrahepatic duct dilation, pneumobilia, contracted gallbladder with thickened wall, dilated small bowel loops and a slight radio-opaque stone (25mm) located in the terminal ileum, suggesting a gallstone ileus (figure 2).
Exploratory laparoscopy revealed a small bowel obstruction, 20cm proximal to the ileocecal valve, caused by a large gallstone (figure 3). Through a Pfannenstiel incision, a 3cm longitudinal enterotomy was made proximal to the gallstone (figure 4). A 5cm stone was removed (figure 5) and the enterotomy was closed transversely. The patient had an uneventful postoperative recovery and was discharged home 4 days later.
Gallstone ileus is a rare cause of mechanical bowel obstruction caused by an impacted stone and an uncommon presentation of gallstone disease (0.5%). The stones are invariable large (>25mm) and obstruction is most frequent at the level of the terminal ileum.1 Management of this condition is usually possible by a small enterotomy, extraction of the stone and primary closure of the bowel.2
1. Chang, L., et al. (2017). Clinical and radiological diagnosis of gallstone ileus: a mini review. Emergency Radiology, 25(2), 189–196. doi:10.1007/s10140-017-1568-5
2. Vera-Mansilla C., et al. (2022). Surgical Treatment of Gallstone Ileus: Less Is More. Visc Med, 38:72-77. doi: 10.1159/000518451
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