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Gallstone ileus, a rare complication of gallstones, causes bowel obstruction, particularly in older women. Early diagnosis and surgical intervention are crucial for managing this condition.

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Emergency medicineSurgery

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Area of Science:

  • Gastroenterology
  • Surgical Pathology

Background:

  • Gallstone disease typically presents as cholecystitis but can manifest as rarer complications.
  • Gallstone ileus involves a gallstone obstructing the gastrointestinal tract, often at the ileocecal valve, via a cholecystoduodenal fistula.

Observation:

  • Gallstone ileus accounts for 1-4% of mechanical bowel obstructions and 25% in those over 65.
  • A 79-year-old woman presented with symptoms of small bowel obstruction.
  • Imaging confirmed a large gallstone causing complete obstruction.

Findings:

  • Diagnosis of gallstone ileus is challenging, with 50% diagnosed intraoperatively.
  • Surgical enterolithotomy successfully removed the obstructing gallstone.
  • The patient experienced postoperative Mobitz type II heart block requiring pacemaker insertion.

Implications:

  • This case highlights the importance of considering gallstone ileus in elderly patients with bowel obstruction and a history of gallstones.
  • Prompt recognition and management are vital for favorable outcomes in gallstone ileus.
  • Understanding rare gallstone complications is essential for comprehensive patient care.