title: A peculiar cause of bowel obstruction.
abstract: BACKGROUND
  Gallstone disease is one of the most common surgical problems necessitating intervention. It is estimated that approximately 15% of people in the western world will develop gallstones. Of these patients, 35% of patients initially diagnosed with gallstones will later develop a complication which will eventually result in cholecystectomy.(2) One of these complications is gallstone ileus, which is a rare complication associated with high morbidity and mortality, and the diagnosis is often missed.(3)
  
  
  METHODS
  A 66 year old female presented with an acute onset of "colicky" abdominal pain accompanied with vomiting. She had known gallstones diagnosed previously by ultrasound. Her abdomen was generally tender with guarding of the right hypochondrium and absent bowel sounds.
  
  
  CONCLUSIONS
  Gallstone ileus accounts for 0.5-4% of all cases of small bowel obstruction, and typically affects females over the age of 65.(3,4) The pathophysiological basis of the disease involves fistulation of the gallstone through the wall of the gallbladder into the bowel, where it becomes impacted and leads to obstruction. Mortality of the condition is not sufficiently reported, but surgical intervention in itself conveys significant morbidity, and mortality has been reported to be 18%.(3,9)
  
  
  CONCLUSIONS
  We report a single large gallstone, which we believe to be one of the largest documented in recent literature, resulting in gallstone ileus. We also present a brief synopsis of the diagnosis and management of the condition, which although rare, should be considered by the astute surgical trainee.
authors.affiliation: Ward C6, Antrim Area Hospital, Bush Road, Antrim BT41 2RL, Northern Ireland, United Kingdom. Electronic address: atuc@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Tucker
authors.forename: I
authors.initials: I
authors.lastname: Garstin
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