Colonic gallstone ileus

Area of Science:

• Gastroenterology
• Radiology
• Surgical Case Reports

Background:

• Gallstone ileus is a rare complication of gallstones, often presenting with small bowel obstruction.
• Cholecystocolic fistula, an abnormal connection between the gallbladder and colon, is an uncommon etiology for gallstone obstruction.
• Accurate diagnosis of gallstone ileus and associated biliary-enteric fistulas can be challenging, requiring a combination of imaging modalities.

Observation:

• A patient presented with symptoms suggestive of bowel obstruction.
• Initial imaging with ultrasound identified the Rigler triad (gallstone in the bowel, intestinal obstruction, and pneumobilia), a sign of gallstone ileus.
• Plain abdominal radiography initially showed only signs of ileus, lacking specific indicators of gallstone obstruction.
• Contrast enema and endoscopic retrograde cholangiopancreatography (ERCP) were unsuccessful in visualizing the suspected biliary-enteric fistula.
• A combined approach using colonoscopy and contrast fistulography definitively identified the cholecystocolic fistula.

Findings:

• The study successfully diagnosed a rare case of colonic gallstone obstruction.
• The Rigler triad was detected by ultrasound, aiding in the initial suspicion of gallstone ileus.
• Visualization of the cholecystocolic fistula required advanced techniques beyond standard contrast studies.
• Colonoscopy and contrast fistulography proved crucial for confirming the biliary-enteric connection.

Implications:

• This case underscores the diagnostic difficulties associated with gallstone ileus, particularly when complicated by a cholecystocolic fistula.
• It highlights the limitations of conventional imaging techniques in detecting biliary-enteric fistulas.
• The findings emphasize the importance of considering advanced imaging and endoscopic procedures for complex gastrointestinal diagnoses.
• Successful identification of the fistula led to appropriate management and improved patient outcomes.