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Gallstone ileus masquerading as a gastric outlet obstruction.

C M Lowther, M Omar

    Southern Medical Journal
    |June 1, 1979
    PubMed
    Summary
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    This case study highlights a patient initially diagnosed with gastric outlet obstruction due to severe gastric retention. However, the actual cause was gallstone ileus, despite the absence of typical radiographic signs.

    Area of Science:

    • Gastroenterology
    • Radiology
    • Geriatric Medicine

    Background:

    • Gallstone ileus is a rare complication of gallstones, occurring when a gallstone erodes through the gallbladder wall into the gastrointestinal tract, causing obstruction.
    • Gastric outlet obstruction is a common condition characterized by blockage at the pylorus, leading to impaired gastric emptying.

    Observation:

    • A patient presented with symptoms suggestive of gastric outlet obstruction, including a markedly distended stomach on abdominal roentgenogram.
    • Classic radiographic indicators for gallstone ileus, such as Rigler's triad (bowel obstruction, ectopic gallstone, and biliary-enteric fistula), were notably absent.
    • The patient's advanced age and history of diabetes mellitus were identified as potential contributing factors to her severe gastric retention.

    Findings:

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    • The patient was diagnosed with gallstone ileus, a condition initially masked by the lack of typical radiological findings.
    • Severe gastric retention was a prominent clinical feature, likely exacerbated by comorbidities.

    Implications:

    • This case underscores the importance of considering atypical presentations of gallstone ileus, particularly in elderly patients with comorbidities.
    • Radiologists and clinicians should maintain a high index of suspicion for gallstone ileus even when classic signs are absent.
    • Prompt diagnosis and management are crucial to prevent complications associated with prolonged gastric retention and intestinal obstruction.