Authors: Trong Anh Nguyen , Lars Leupolt , Carolin Fischer , Eberhard Schneider

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Article Info

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Abstract

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Background: Gallstone ileus is a rare complication of cholelithiasis caused by a bilioenteric fistula. Besides clinical examination, computer tomography (CT) scan is considered a radiological diagnostic procedure. Case Presentation: A 68-year-old male patient presented with epigastralgia, nausea, and emesis. The abdomen was distended and diffusely painful to palpation with peritoneal irritation. Auscultation showed raised peristaltic sounds. CT scan showed aerobilia, distension of the stomach, duodenum, and proximal jejunum, and inside it a 3.5 cm calcified round foreign body. Exploratory laparoscopy showed jejunum obstruction and chronic inflammation of the gallbladder. Lifting the small bowel through a small laparotomy was performed for gallstone removal. After recovery a delayed cholecystectomy and fistula closure followed. Hospital stays were short and complication-free. Conclusion: There are no guidelines for the management of gallstone ileus yet because of a limited number of reported cases. Most of the bilioenteric fistulas are located between the gallbladder and duodenum. In cases of biliocolonic fistula, causing obstruction in the colon endoscopic or conservative therapy can also be performed with a success rate of 26%. Surgical treatment is still a common procedure in emergency cases.

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Keywords: Gallstone ileus, bilioenteric fistula, surgical treatment, delayed cholecystectomy, fistula closure, green

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