EmergencyRadiology(2002) 9: 110–112
DOI 10.1007/s10140-002-0203-1
CASE REPORT
Sangeeta Guttikonda Æ Kuldeep K. Vaswani
Kenneth M. Vitellas
Recurrent gallstone ileus: a case report
Published online: 24 April 2002
Ó ASER 2002
Abstract Gallstone ileus is a rare complication of
Case report
recurrent gallstone cholecystitis and usually occurs in
elderlyfemale patients. Recurrent gallstone ileus occurs
in 5% of patients with a previous episode of gallstone
ileus and is associated with a mortalityof 20%. We
present a 52-year-old female with recurrent gallstone
ileus 1 year after her initial episode.
A 52-year-old woman who had suffered from gallstone ileus 1 year
previously, treated with enterolithotomy without cholecystectomy,
presented to the emergencydepartment with a historyof abdomi-
nal pain increasing over 4 days, nausea, and vomiting. She had
been admitted to the hospital 1 week earlier for partial small bowel
obstruction.
Contrast-enhanced CT of the abdomen and pelvis revealed
distended proximal small bowel loops with an intraluminal filling
defect in the distal ileum. The small bowel beyond this point was of
normal caliber. Due to the possibilityof an intraluminal mass, a
small bowel follow-through was performed (Fig. 1). This revealed a
choledochoduodenal fistula with multiple sinus tracts arising from
the duodenum and a round intraluminal filling defect in the distal
Keywords Small bowel obstruction Æ Gallstone ileus
Introduction
Gallstone ileus accounts for 1–3% of all small bowel ileum, demonstrating small bowel obstruction. In addition, gas was
identified within the biliarytree. The patient was diagnosed with
gallstone ileus.
patients over 65 years of age [1, 2]. In addition, it
Because the patient presented with recurrent gallstone ileus,
obstructions with an incidence of up to 25% in
complicates 0.3–0.5% of all cases of cholelithiasis [2].
cholecystectomy along with repair of the choledochoduodenal fis-
Recurrent gallstone ileus occurs in 5% of patients with tula and enterolithotomywas performed. A large, impacted 2.2-cm
stone was removed from the terminal ileum. The patient recovered
and was discharged on the tenth postoperative daywith no com-
plications in short-term follow-up.
a previous episode of gallstone ileus [3, 4]. It is defined
as a mechanical intestinal obstruction from a second
biliarycalculus that was either present in the bowel or
in the gallbladder at the time of the initial episode
of gallstone ileus. Because it is associated with a very
high overall mortality– 20% [3] – the emergency
physician must have a high index of suspicion of this
Discussion
Adhesions and hernias account for 80% of all cases of
entityin anypatient with a historyof gallstone ileus
small bowel obstruction [5]. Other, less common causes
who presents with acute abdominal pain. Treatment
include malignancies, inflammatoryprocesses, intussus-
is surgical and usuallyinvolves removal of the
ception, volvulus, gallstones, and foreign bodies [5].
obstructed stone through an enterotomy, cholecystec-
Gallstones are responsible for small bowel obstruction
tomy, and repair of the biliary–enteric fistula in a
in 1–3% of the general population. However, gallstone
one-stage procedure.
ileus occurs in up to 25% of patients over the age of 65,
and is seven times more common in women [1, 2].
The pathophysiology of gallstone ileus is as follows.
The gallbladder becomes inflamed secondaryto c ys tic
duct obstruction bya gallstone and becomes adherent to
S. Guttikonda Æ K.K. Vaswani Æ K.M. Vitellas (&)
The Ohio State UniversityMedical Center,
Department of Radiology, S-211 Rhodes Hall,
the adjacent duodenum or, less frequently, stomach,
common bile duct, or colon. Ischemia and erosion of the
wall of the gallbladder and adjacent viscus ensue, and a
cholecystoenteric fistula is formed through which the
gallstone passes [6, 7]. The stone maylodge at various
levels, causing intermittent small bowel obstruction
4
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E-mail: vitellas.2@osu.edu
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