Sigmoid gallstone ileus: a challenging diagnosis

Area of Science:

• Gastroenterology
• Pathology
• Surgical Case Report

Background:

• Gallstone ileus is a rare complication of gallstone disease, usually causing small bowel obstruction.
• It is more prevalent in elderly patients with comorbidities.
• Large bowel obstruction due to gallstone ileus is exceptionally uncommon.

Observation:

• A 95-year-old woman presented with abdominal pain.
• CT revealed a foreign body in the sigmoid colon, later identified as a gallstone.
• Autopsy confirmed colonic perforation by the impacted gallstone.

Findings:

• The gallstone perforated the sigmoid colon at a site of fibrotic narrowing and diverticula.
• The gallbladder contained a matching stone and showed signs of necrosis.
• Peritonitis secondary to colonic perforation was the cause of death.

Implications:

• This case underscores the potential for gallstones to cause rare forms of gastrointestinal obstruction.
• It highlights the importance of considering gallstone disease in elderly patients with bowel obstruction, even in the large bowel.
• Autopsy findings revealed a unique presentation of gallstone ileus leading to fatal colonic perforation.