Cholecystostomy does not prevent gallstone ileus: a case report.
BACKGROUND
Gallstone ileus following cholecystostomy has been reported once, in a patient with acute cholecystitis, where symptoms of small intestinal obstruction had developed one day after surgery. We report a case of gallstone ileus eight months following a cholecystostomy, which might deter the diagnosis. This is the only such reported case in medical literature according to our knowledge.


METHODS
A 54-year-old Sri Lankan female with a past history of a cholecystostomy presented with symptoms suggestive of small intestinal obstruction. Evidence of ileal obstruction with pneumobilia in the supine radiograph of the abdomen and cholecyto-duodenal fistula in the water soluble contrast study was suggestive of the diagnosis of gallstone ileus. An enterolithotomy was performed with no attempt of closure of the cholecysto-duodenal fistula.


CONCLUSIONS
This case demonstrates the value of the supine radiograph of the abdomen and the barium follow-through in diagnosis. A cholecystogram, preferably preoperative, is the mainstay of prevention and identification of this clinical scenario.
Siriwardana
Pulathis Nilantha
PN
University Surgical Unit, Colombo South Teaching Hospital S De S Jayasinghe Road, Kalubowila, 10350 Sri Lanka. pulathis_ns@yahoo.co.uk
Weerasekara
Deepaka
D
De Silva
Mohan
M