DANİEL KOSTOV, VASİL KOSTOV
Journal of Clinical Practice and Research - 2019;41(4):450-452
Gallstone ileus is an infrequent complication of cholelithiasis, which manifests as small distended intestinal loops containing the characteristic radiographic patters of “air-fluid levels.” Cholelithiasis is associated with high rates of morbidity and mortality. A 64-year-old woman was admitted to the hospital with a history of abdominal pain, nausea, multiple episodes of bilious vomiting, distention, and constipation that had been occurring continuously since the past 7 days. Clinical examination revealed bloating and diffused tenderness in the abdomen. There was no rebound and no defense. Computed Tomography (CT) of the abdomen showed air-fluid levels in small bowel segments, a 50×35 mm calcified gallstone that was obstructing the terminal ileum, air in the gallbladder, and a large impacted ileal gallstone. The patient underwent laparoscopic repair of a cholecystoduodenal fistula, cholecystectomy, and removal of a gallstone by enterotomy with subsequent reconstruction of the terminal ileum. The patient was discharged on the 5th postoperative day with a full resolution of symptoms and no complications. CT of the abdomen is a useful aid in the diagnosis of cholecystoduodenal fistula and gallstone ileus. If the patient’s medical condition is stable and suitable, a one-stage laparoscopic approach with concurring enterotomy, cholecystectomy, and fistula resection is a worthwhile endeavor.
