A chip off the old block—A case report of gallstone ileus in which identification of a facetted stone was essential in preventing re-laparotomy. (2017)

• Record Type: Journal Article
• Authors: O'Kelly, James; Begg, Paul; Anderson, David
• Is Part Of: International journal of surgery case reports. Volume 38(2017)
• Page Start: 95
• Page End: 97
• Publication Date: 2017
• Subjects: Gallstone -- Ileus -- Laparotomy -- Obstruction; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.06.039
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Interesting case discussing a comparatively rare but serious presentation. Important operative learning point to avoid return to theatre and associated morbidity/mortality. Excellent intra-operative images to highlight learning points. Abstract: Gallstone ileus is a rare presentation, accounting for 0.1% of cases of mechanical small bowel obstruction. Patients are often elderly with significant comorbidity. Treatment is based upon laparotomy and enterolithotomy. We present the case of a 75 year old lady admitted as an emergency with a 4 day history of small bowel obstruction. She was found on CT scan to have an impacted gallstone in the distal ileum. At operation, her impacted stone was removed through a proximal enterostomy. The stone however was found to have a squared off edge, raising the suspicion of a second fragment within the proximal small bowel lumen. Failure to retrieve this could have led to re-obstruction requiring a return to theatre and repeat laparotomy in an elderly patient with the associated morbidity.