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Small bowel obstruction secondary to gallstone ileus: An unusual presentation of cholelithiasis
Shishir Devkota1, Prajjwol Luitel2, Sujan Paudel2
1Department of General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Introduction And Importance:
Gallstone ileus remain a rare but significant cause of small bowel obstruction, especially in the elderly population. It is associated with high mortality due to nonspecific symptoms and delayed diagnosis.
Case Presentation:
A 69-year-old male with a history of cholelithiasis presented with symptoms and signs suggestive of small bowel obstruction. Computed tomography (CT) scan showed pneumobilia, and small bowel obstruction, suggestive of gallstone ileus. Initial management involved exploratory laparotomy with enterotomy and gallstone removal followed by cholecystectomy and fistula closure three months later.
Clinical Discussion:
Gallstone ileus results from large gallstones causing mechanical intestinal obstruction, often via a cholecysto-intestinal fistula. CT scans are crucial for diagnosis, with surgical options for better patients' outcomes. Management of gallstone ileus involves removing the obstruction and repairing the cholecysto-intestinal fistula, but surgical approaches vary based on patient factors.
Conclusion:
Surgeons should be aware of the variable clinical presentations and the rationale behind choosing either a one-stage or staged surgical approach, particularly in managing patients with fistulas or severe adhesions.
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