Colonic Perforation Secondary to Gallstone Impaction in the Sigmoid Colon

Area of Science:

• Gastroenterology
• Surgical Pathology

Background:

• Gallstone sigmoid ileus is an exceptionally rare condition leading to large bowel obstruction.
• Predisposing factors include cholecystitis with cholecysto-colonic fistula, large gallstones, and sigmoid colon narrowing (diverticular disease or malignancy).

Observation:

• An 82-year-old male presented with severe constipation, tachypnea, tachycardia, hypotension, and elevated lactate.
• Physical examination revealed peritonism, abdominal distention, and guarding.
• CT scan identified sigmoid colon perforation due to an impacted gallstone.

Findings:

• Laparotomy confirmed sigmoid perforation and generalized feculent peritonitis.
• The patient underwent Hartmann's procedure.
• Postoperative complications related to hemodynamic instability led to mortality on the third postoperative day.

Implications:

• Complicated sigmoid gallstone ileus necessitates prompt surgical intervention.
• While uncomplicated cases may be managed endoscopically or with enterolithotomy, perforation demands immediate surgical treatment like Hartmann's procedure.
• This case underscores the critical nature of prompt management in advanced gallstone ileus presentations.