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Gallstone ileus with two separate biliary-enteric fistulae.

The Journal of Family Practice

|August 1, 1986

Summary

This case report details a rare instance of gallstone ileus complicated by two biliary-enteric fistulae, ultimately revealing gallbladder adenocarcinoma. Early diagnosis of gallstone ileus is crucial, especially in elderly patients with cholelithiasis.

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Area of Science:

Gastroenterology
Surgical Oncology
Diagnostic Imaging

Background:

Gallstone ileus is a rare complication of cholelithiasis.
Biliary-enteric fistulae can complicate gallstone ileus, presenting diagnostic challenges.

Observation:

A patient presented with symptoms of bowel obstruction, later diagnosed with gallstone ileus and two biliary-enteric fistulae.
Initial plain abdominal films were inconclusive for gallstone ileus.
Pathology revealed gallbladder adenocarcinoma, which was not suspected pre-operatively.

Findings:

Surgical intervention included gallstone removal, fistula repair, and cholecystectomy.
Gallbladder adenocarcinoma was an incidental finding.
The patient recovered and was discharged 14 days post-surgery.

Implications:

Highlights the importance of considering gallstone ileus in elderly patients with cholelithiasis and bowel obstruction symptoms.
Emphasizes the utility of advanced imaging modalities (contrast studies, ultrasound, hepatobiliary scan) when plain films are non-diagnostic.
Underscores the potential for unexpected malignancy in patients presenting with complicated gallstone disease.

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