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) - O'Kelly, James
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.