Gallstone ileus presenting as obstructive gangrenous appendicitis

Area of Science:

• Gastroenterology
• Surgical Pathology

Background:

• Acute appendicitis and intestinal obstruction are common surgical emergencies.
• Gallstone ileus typically involves small bowel obstruction, not appendiceal obstruction.

Observation:

• A 38-year-old woman presented with acute appendicitis and intestinal obstruction.
• Intraoperative findings revealed a 2.5 cm gallstone impacted at the base of the cecal appendix, causing gangrene and obstruction.
• A choledochal-duodenal fistula was also identified, with no remaining gallstones in the gallbladder.

Findings:

• The gallstone found in the appendix contained cholesterol and calcium bilirubinate, mimicking an appendicolith on initial imaging.
• Appendectomy with gallstone retrieval was performed; no further intervention for the fistula or gallbladder was deemed necessary due to the absence of other gallstones.

Implications:

• This case underscores the unusual presentation of gallstone ileus causing obstructive gangrenous appendicitis.
• Clinicians should consider gallstone ileus in the differential diagnosis of appendicitis, especially with atypical appendicolith findings.