Diagnosis and treatment of a patient with gallstone ileus.
BACKGROUND
A 79-year-old white woman presented with upper abdominal pain. She had a history of rheumatoid arthritis since she was 19 years old, which was treated with prednisolone, leflunomide, diclofenac and pantoprazole. She also had factor VII deficiency. The patient had been hospitalized 2 months previously with sepsis presumed to be due to urinary infection, and was treated with antibiotics. Sonography at this time revealed a gallbladder with a monstrous thick wall and stones, and the first differential diagnosis was cholecystitis. Cholecystectomy was planned after amelioration of the patient's general state, but her general state worsened.


METHODS
Sonography, endoscopy of the upper and lower intestine, and CT scan.


METHODS
Biliodigestive fistula and gallstone ileus.


RESULTS
Enterolithotomy, stenting, endoscopic retrograde cholangiopancreatography, and surgery.
Zuber-Jerger
Ina
I
University Hospital of Regensburg, Germany. ina.zuber-jerger@klinik.uni-regensburg.de
Kullmann
Frank
F
Schneidewind
Arno
A
Schölmerich
Jürgen
J
D000368:Aged; D013505:Digestive System Surgical Procedures; D016099:Endoscopy, Gastrointestinal; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D045823:Ileus / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D019919:Prosthesis Implantation; D015607:Stents