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[A man with lower left abdominal pain].

Wessel M C M Vorselaars1,2, Miriam M van Heeswijk3, D J G H Roks1

  • 1UMC Utrecht, afd. Heelkunde.

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Summary

Gallstone ileus, a rare condition, occurred in a 57-year-old man presenting with abdominal pain. A gallstone caused a blockage and fistula between the gallbladder and colon, requiring surgical intervention.

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Area of Science:

  • Gastroenterology
  • Abdominal Surgery

Background:

  • Gallstone ileus is a rare complication of cholelithiasis, occurring when a gallstone erodes through the gallbladder wall and into the gastrointestinal tract.
  • It most commonly obstructs the small intestine, but can also affect the colon.

Observation:

  • A 57-year-old male presented with fever and left lower quadrant abdominal pain.
  • CT scan revealed gallbladder wall thickening, a fistula to the transverse colon, descending colon calcification, and distended bowel loops.

Findings:

  • The patient was diagnosed with gallstone ileus secondary to a gallstone migrating from the gallbladder to the colon.
  • A fistula between the gallbladder and the transverse colon was identified as the pathway.

Implications:

  • Prompt diagnosis and surgical intervention, such as sigmoidotomy for stone extraction, are crucial to prevent complications like colon blow-out.
  • This case highlights the importance of considering gallstone ileus in patients with atypical abdominal pain and relevant CT findings.