title: A novel surgical approach for treatment of sigmoid gallstone ileus.
abstract: We report a rare case of large bowel obstruction secondary to a gallstone impacted within the sigmoid colon, in the presence of sigmoid diverticular disease. An 89-year-old woman presented with an 8-day history of increasing abdominal distension, pain and associated nausea. Abdominal X-ray demonstrated large bowel dilation. CT scan revealed a fistula between an inflamed gallbladder and the hepatic flexure of the colon, with a large gallstone in the sigmoid colon. Proximal dilated large bowel was evident to the caecum. Flexible sigmoidoscopy was performed as the least invasive potential treatment method with a view to basket retrieval or fragmentation of the stone. Owing to poor views and risk of diverticular perforation, the procedure was abandoned, hence laparotomy was performed. Antegrade manipulation and per-rectal evacuation were attempted but failed due to a thickened, angulated sigmoid colon. Retrograde milking of the stone to the caecum and retrieval via modified appendicectomy was successful.
authors.affiliation: Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Abbey
authors.identifier: http://orcid.org/0000-0002-0869-1702
authors.initials: A
authors.lastname: Cargill
authors.affiliation: Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Farkas
authors.affiliation: Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: John
authors.initials: J
authors.lastname: Black
authors.affiliation: Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: West
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods; D012809:Colon, Sigmoid / Q000473:pathology; D005260:Female; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D045823:Ileus / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012810:Sigmoid Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology*