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a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2017; 71(5): 439–444. doi:10.14735/amgh2017439.

An unusual case of gallstone ileus

Jan Hadač1, Barbora Novotná1, Mojmír Kasalický2,3

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The authors report a very rare case of biliary ileus, which was caused by biliary obstruction in the area of the oral rectum. In available scientific publications, the authors did not find a similar case in which the localisation of a biliary fragment in the digestive tract resulted in its obstruction. One of the reasons may be because it is sometimes very difficult to perform preoperative diagnostics, as also demonstrated in this case study. In an 82-year-old patient, the development of distal biliary ileus is a rare complication, the primary manifestation of which is asymptomatic cholecystolithiasis. Paraclinic examinations did not show preoperative pneumonia (free air in bile ducts) or X-ray contrast gall stones in the gastrointestinal tract. The primary diagnosed sublingual condition may have been caused by incomplete lumen obstruction in the upper gastrointestinal tract or sigma followed by a further peristaltic shift and wedging of the biliary stalk in the upper rectum, resulting in a complete ileus. Treatment of bile ileus is still predominantly surgical; in our case study, surgical revisions were both curative and surprisingly  diagnostic.


Hartmann operation, Riegler's trias, gallstone ileus

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