title: Gallstone ileus: a case report and review of the literature.
abstract: Gallstone ileus is a rare complication of gallstone disease, accounting for 1-4% of all bowel obstructions. The phisiopathology is related to the presence of a bilio-enteric fistula. Cholecistoenteric fistulae occur in fewer than 1% of patients with gallstone. We present the case of an 83-years-old woman, complaining of acute abdominal pain, vomiting and mechanical obstruction at admission. She reported a past history of hypertension, recent miocardial ischaemia, diverticular disease and cholelithiasis. A CT scan revealed aerobilia, gastric and duodenal dilatation and a gallstone impacted just beyond the duodeno-jejunal junction. An exploratory supraumbilical laparotomy was performed: revealing a 4-cm gallstone impacted just caudal to the Treitz ligament. We then performed an enterolithotomy. According to the literature, enterolithotomy is the most commonly used surgical technique, whereas enterolithotomy combined with cholecistectomy and fistulectomy is indicated only in selected cases. The clinical presentation depends on impaction site and generally includes abdominal pain, nausea and vomiting. Some cases may present haematemesis due to mucosal erosion. The gold-standard investigation technique is CT scan.
authors.affiliation: Department of Surgical, Anaesthesiological and Digestive Diseases Sciences, IIth Faculty of Medicine, University Sapienza, Sant'Andrea Hospital, Rome.
authors.forename: Marcello
authors.initials: M
authors.lastname: Gasparrini
authors.forename: Andrea
authors.initials: A
authors.lastname: Liverani
authors.forename: Valeria
authors.initials: V
authors.lastname: Catracchia
authors.forename: Stefano
authors.initials: S
authors.lastname: Conte
authors.forename: Giacomo
authors.initials: G
authors.lastname: Leonardo
authors.forename: Graziella
authors.initials: G
authors.lastname: Marino
authors.forename: Andrea
authors.initials: A
authors.lastname: Milillo
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Mari
authors.forename: Massimo
authors.initials: M
authors.lastname: Pezzatini
authors.forename: Francesco
authors.initials: F
authors.lastname: Favi
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D045823:Ileus / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery