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Cholecystostomy does not prevent gallstone ileus: a case report
Pulathis Nilantha Siriwardana1, Deepaka Weerasekara, Mohan De Silva
1University Surgical Unit, Colombo South Teaching Hospital S De S Jayasinghe Road, Kalubowila, 10350 Sri Lanka. pulathis_ns@yahoo.co.uk
Cases Journal
|October 16, 2009
Summary
Gallstone ileus can occur months after cholecystostomy, complicating diagnosis. Early imaging like abdominal X-rays and contrast studies are crucial for identifying this rare complication.
Area of Science:
- Gastroenterology
- Surgical Complications
- Abdominal Imaging
Background:
- Gallstone ileus is a rare complication of gallstones.
- Cholecystostomy is a procedure to drain the gallbladder.
- Gallstone ileus following cholecystostomy is exceptionally rare.
Observation:
- A 54-year-old female presented with symptoms of small intestinal obstruction eight months after a cholecystostomy.
- Imaging revealed ileal obstruction, pneumobilia, and a cholecysto-duodenal fistula.
- Diagnosis of gallstone ileus was suspected based on these findings.
Findings:
- An enterolithotomy was performed to remove the gallstone causing the obstruction.
- The cholecysto-duodenal fistula was not surgically closed.
- This case represents a delayed presentation of gallstone ileus post-cholecystostomy.
Implications:
- Highlights the importance of considering gallstone ileus in patients with prior cholecystostomy presenting with obstruction.
- Emphasizes the diagnostic value of supine abdominal radiography and water-soluble contrast studies.
- Suggests preoperative cholecystography as a preventive measure to identify potential risks.
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