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Jejunal perforation in gallstone ileus - a case series
Louise E Browning1, Jeremy D Taylor, Sue K Clark
1Department of Surgery, University Hospital Lewisham, Lewisham, UK. browninglouise@hotmail.com.
Journal of Medical Case Reports
|November 30, 2007
Summary
Gallstone ileus can cause rare jejunal perforations, including a unique case of a perforated jejunal diverticulum. These complications highlight the risks of gallstone ileus and small bowel diverticula.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Abdominal Surgery
Background:
- Gallstone ileus, a rare complication of gallstones, causes mechanical bowel obstruction, particularly in the elderly.
- Small intestinal perforation proximal to an obstructing gallstone is exceptionally uncommon.
- This report details two cases of jejunal perforation secondary to gallstone ileus.
Purpose of the Study:
- To present two rare cases of jejunal perforation in the context of gallstone ileus.
- To highlight a unique instance of gallstone ileus causing perforation of a jejunal diverticulum.
- To increase awareness of potential complications associated with gallstone ileus and jejunal diverticula.
Main Methods:
- Case 1: Laparotomy for small bowel obstruction revealed a gallstone ileus with jejunal perforation; surgical resection was performed.
- Case 2: CT scan identified aerobilia and distal ileal obstruction by a gallstone; laparotomy showed a perforated jejunal diverticulum, treated with enterolithotomy and resection.
Main Results:
- Two elderly male patients presented with symptoms of small bowel obstruction.
- Case 1 demonstrated gallstone ileus with direct jejunal perforation.
- Case 2 presented a unique complication: gallstone ileus-induced perforation of a jejunal diverticulum.
Conclusions:
- Gallstone ileus poses diagnostic challenges and carries high morbidity/mortality, especially in the elderly.
- Jejunal perforation in gallstone ileus is rare, occurring via pressure necrosis or secondary to diverticular perforation.
- Increased vigilance for these rare complications in gallstone ileus and jejunal diverticula is warranted.
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