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case_report·surgery, gastroenterology, emergency medicine, internal medicine·PMC10553159

Small intestinal obstruction due to a giant gallstone: a rare case report from Syria

Annals of Medicine and Surgery · 5 authors, 3 centres

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This case report describes a woman in her 50s with type 2 diabetes who presented to the emergency department with abdominal pain, vomiting, and constipation for 3 days.

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This case report describes a woman in her 50s with type 2 diabetes who presented to the emergency department with abdominal pain, vomiting, and constipation for 3 days. The patient underwent laparotomy with enterolithotomy, cholecystectomy, and two-layer fistula closure. She received postoperative intravenous antibiotics and nutrition and was discharged 8 days later without complications. The authors note that gallstone ileus occurs in less than 0.5% of cholelithiasis patients and predominantly affects elderly females.

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case_report

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surgery

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ORIGINAL PAPER

PMC10553159

Small intestinal obstruction due to a giant gallstone: a rare case report from Syria

Annals of Medicine and Surgery

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ABSTRACT

Abstract Introduction and importance: Gallstone ileus is a rare and potentially life-threatening condition characterized by the obstruction of the small intestine due to a gallstone. It occurs as a complication of gallstone disease, where a large gallstone erodes through the gallbladder into the gastrointestinal tract, creating a fistula. Case presentation: A type 2 diabetic woman in her 50s presented to the emergency department complaining of abdominal pain and vomiting. She has not emptied her bowels since 3 days ago. A clinical examination showed tenderness in the abdomen associated with fecal vomiting. A computed tomography (CT) scan was performed and showed a dilated gallbladder with gas. A giant gallstone in a small intestinal loop was observed. The diagnosis was a small intestinal obstruction due to a giant gallstone and a duodenal-biliary fistula. Clinical discussion: Gallstone ileus is an occasional complication of cholelithiasis, occurring in less than 0.5% of patients. Gallstone ileus frequently occurs in the terminal ileum and the ileocecal valve. Regarding the clinical presentation, abdominal pain is the most common symptom, followed by vomiting and constipation. CT scan is the gold standard utilized to diagnose gallstone ileus. Surgical intervention is the mainstay treatment for giant gallstone ileus, with enterolithotomy being the most commonly performed procedure. Conclusion: Gallstone ileus is an uncommon but potentially life-threatening condition that can emerge in elderly patients with a history of cholelithiasis. It is crucial for clinicians to maintain a high index of suspicion when encountering older patients with risk factors for cholelithiasis and intestinal obstruction. Keywords: cholelithiasis, gallbladder, gallstone, giant, ileus, obstruction

CITATION EXPORT

Farah Suleiman, Ghazal Suleiman, Abdulrahman Shbani et al.. Small intestinal obstruction due to a giant gallstone: a rare case report from Syria. Annals of Medicine and Surgery. (2023). https://doi.org/10.1097/MS9.0000000000001211

AUTHORS

5 · 3 CENTRES

Farah Suleiman, Ghazal Suleiman, Abdulrahman Shbani, Ahmad Hasan, Moatasem Hussein Al-janabi

a Faculty of Medicine, Tartous University
bUniversity of Tartous, Tartous
cDepartment of Pathology, Cancer Research Center, Tishreen University Hospital, Lattakia, Syria