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02 May 2016 : Case report  Qatar

An Unusual Presentation of Gallstone Ileus: A Red-Herring or Missed Diagnosis

Unusual clinical course, Mistake in diagnosis, Educational Purpose (only if useful for a systematic review or synthesis)

Saif Al-MudaresABDEF, Mohamed KurerABE, Renol M. KoshyABDEF, Ayman El-MenyarDEF

DOI: 10.12659/AJCR.897646

Am J Case Rep 2016; 17:301-304

Abstract

BACKGROUND: Gallstone ileus is a rare complication of chronic calcular cholecystitis and an uncommon etiological entity responsible for mechanical intestinal obstruction. The most common obstructed part is the narrow terminal ileum, whereas the jejunum is rarely affected. The gallstone is postulated to reach the small bowel by gradual erosion from the gall bladder, most commonly into the duodenum, forming a cholecysto-duodenal fistula.

CASE REPORT: Herein, we report a 72-year-old male who presented with intestinal obstruction of a 5-day duration, with a clinical diagnosis of an irreducible inguinal hernia. However, the patient continued to be symptomatic following an uncomplicated hernioplasty. A computerized tomography (CT) scan of the abdomen revealed a small bowel lesion, which intra-operatively was confirmed to be an impacted gallstone in the jejunum with a cholecysto-duodenal fistula.

CONCLUSIONS: Despite gallstone is uncommon cause of intestinal obstruction, a high index of suspicion with a careful CT scan interpretation is the key to the diagnosis, especially when there is a red-herring distracting the attention, like irreducible hernia in this case.

Keywords: Biliary Fistula - complications, Gallstones - diagnosis, Ileus - etiology, Intestinal Fistula - complications, Intestinal Obstruction - etiology, Jejunal Diseases - etiology

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923