Small bowel obstruction

Authors


Key Clinical Message

Gallstone ileus is a rare complication of cholelithiasis, but an established cause of mechanical small bowel obstruction in elderly patients. It is associated with high morbidity and mortality as most patients are elderly with multiple comorbidities. Surgery of choice is enterolithotomy.

Question

What condition does this patient have and how is it treated? (Fig. 1)

  1. Ingested bezoar and small bowel resection.
  2. Small bowel tumor and small bowel resection.
  3. Gallstone ileus and enterolithotomy.
  4. Malrotation and detorsion of small bowel.
  5. Meckel's diverticulum and diverticulectomy.
Figure 1.

Demonstrates gallstone in the lumen of the small bowel.

Answer – 3 Gallstone ileus and enterolithotomy

Gallstone ileus is a rare complication of cholelithiasis, but an established cause of mechanical small bowel obstruction in elderly patients. It is associated with high morbidity and mortality as most patients are elderly with multiple comorbidities. Surgery of choice is enterolithotomy alone in unstable patients and it is associated with lower morbidity and mortality, lower operative time, and shorter hospital stay. Interval cholecystectomy with fistula repair can be performed in these patients once they have recovered from the acute episode. The other surgical option in young and stable patient is to perform enterolithotomy, cholecystectomy, and fistula repair in one stage [1, 2].

Conflict of Interest

None declared.

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