Gallstone ileus

A 64‐year‐old man with underlying hypertension and hyperlipidaemia presented with abdominal distension, vomiting and no bowel movement for 2 days. He had no history of fever. He had previous history of adrenalectomy for Conn’s adenoma. Examination revealed mild epigastric tenderness. Abdominal x‐ray showed dilated small bowels (Figure, A; blue arrow) and two rounded opacities in the right hypochondrium and right iliac fossa (Figure, A; red arrows). Computed tomography scan of the abdomen demonstrated small bowel obstruction secondary to gallstone ileus (Figure, B), and pneumobilia (Figure, C; red arrow) and contrast (Figure, C; blue arrow) in the gallbladder, suggestive of cholecystoduodenal fistula. Multiple subcentimetre stones were also found in the gallbladder and common bile duct. He underwent exploratory laparotomy and enterolithotomy.

Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract, and accounts for less than 1% of cases of intestinal obstruction.1 The signs and symptoms of gallstone ileus are non‐specific, although 40–50% of patients may have previous history of biliary colic, jaundice or acute cholecystitis.1 The most common site of gallstone impaction is at the distal ileum (60%) because of its narrow calibre and lower peristaltic activity.2