title: What to do with a non-rolling stone? Surgical on-table dilemma in large bowel obstruction due to an impacted gallstone.
abstract: We present a rare case of large bowel obstruction secondary to colonic gallstones in a frail nonagenarian. Uniquely, the stone was impacted in the descending colon-sigmoid junction, in the absence of underlying bowel pathology distal to the stone. In light of worsening pain and distension after failed endoscopic treatment, the patient was treated with an emergency laparotomy. After an on-table dilemma, a proximal defunctioning loop colostomy was fashioned and the stone left in situ, with the eventual fate of the stone currently undecided. We also discuss alternative treatment options and explain the thought processes that lead to our decision.
authors.affiliation: Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, UK niloyd@aol.com.
authors.forename: Niloy
authors.initials: N
authors.lastname: Das
authors.affiliation: Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, UK.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Plummer
authors.affiliation: Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, UK.
authors.forename: Hassan
authors.initials: H
authors.lastname: Raja
authors.affiliation: Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, UK.
authors.forename: Ashok
authors.initials: A
authors.lastname: Vashist