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Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Abdominal Imaging

Background:

  • Gallstone ileus is a rare complication of gallstones, typically causing small bowel obstruction.
  • Cholecystoenteric fistulation is the underlying mechanism, allowing gallstones to enter the gastrointestinal tract.
  • Large-bowel obstruction due to gallstone ileus is exceptionally uncommon.

Observation:

  • A 75-year-old woman presented with acute symptoms after bowel preparation for colonoscopy.
  • Investigations revealed a cholecystocolic fistula and a giant gallstone obstructing the rectosigmoid junction.
  • The patient experienced symptoms of large-bowel obstruction.

Findings:

  • Preintervention imaging confirmed a cholecystocolic fistula and a large gallstone causing distal large-bowel obstruction.
  • Initial conservative management was unsuccessful.
  • Surgical intervention, including laparotomy and Hartmann's procedure, was required.

Implications:

  • This case highlights a rare presentation of gallstone ileus involving the colon.
  • Prompt diagnosis and surgical intervention are crucial for managing large-bowel obstruction secondary to gallstone impaction.
  • Understanding rare fistulating pathways is important for surgical planning and patient outcomes.