An unusual case of gallstone ileus
Jan Hadač1, Barbora Novotná1, Mojmír Kasalický2,3
1 Chirurgická klinika 2. LF UK a ÚVN – VFN Praha
2 Chirurgická klinika, 2. LF UK a ÚVN – VFN Praha
3 Fakulta zdravotníctva a sociálnej práce, Trnavská univerzita v Trnave
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.
KeywordsHartmann operation, Riegler's trias, gallstone ileus
To read this article in full, please register for free on this website.
Benefits for subscribers
Benefits for logged users
1. Clavien PA, Richon J, Burgan S et al. Gallstone ileus. Br J Surg 1990; 77 (7): 737–742.
2. Mallipeddi MK, Pappas TN, Shapiro ML et al. Gallstone ileus: revisiting surgical outcomes using National Surgical Quality Improvement Program data. J Surg Res 2013; 184 (1): 84–88. doi: 10.1016/j.jss.2013.05.027.
3. Ayantunde AA, Agrawal A. Gallstone ileus: diagnosis and management. World J Surg 2007; 31 (6): 1292–1297.
4. Van Hillo M, van der Vliet JA, Wiggers T et al. Gallstone obstruction of the intestine: an analysis of ten patients and a review of the literature. Surgery 1987; 101 (3): 273–276.
5. Halabi WJ, Kang CY, Ketana N et al. Surgery for gallstone ileus: a nationwide comparison of trends and outcomes. Ann Surg 2014; 259 (2): 329–335. doi: 10.1097/SLA. 0b013e31827eefed.
6. Beltran MA, Csendes A, Cruces KS. The relationship of Mirizzi syndrome and cholecystoenteric fistula: validation of a modified classification. World J Surg 2008; 32 (10): 2237–2243. doi: 10.1007/s00268-008-9660-3.
7. Basili G, Lorenzetti L, Celona G et al. Gall-stone ileus in patient with Crohn’s disease: report of a clinical observation. Surg Endosc 2006; 20 (4): 703–704.
8. Deitz DM, Standage BA, Pinson CW et al. Improving the outcome in gallstone ileus. Am J Surg 1986; 151 (5): 572–576.