AB155. SOH24AB_272. Gallstone ileus: an unusual cause of intestinal obstruction

Background: We describe a case of small intestinal obstruction due to gallstone ileus, and discuss this condition as a learning point for trainee surgeons. We also discuss treatment options for this rare condition.

Methods: We report the case of a 77-year-old male who presented with symptoms and signs of small intestinal obstruction. The patient described a 4-day history of nausea and vomiting, with associated constipation, abdominal pain and general weakness. On clinical examination, the patient appeared pale, dehydrated and generally unwell, with abdominal distension and tenderness. Laboratory investigations were consistent with metabolic acidosis, and serum inflammatory markers were elevated. Initial radiological investigation confirmed evidence of small bowel obstruction and a probable gallstone in the ileum.

Results: In view of the above clinical and radiological signs, it was determined that the patient had gallstone ileus and required emergency resuscitation and surgical management. Operative treatment was carried out in the form of emergency laparotomy and enterolithotomy. The patient made a good post-operative recovery and did not require any further surgical intervention.

Conclusions: Gallstone ileus represents 4% of cases of bowel obstruction in the general population, but increases to 25% in patients above the age of 65 years. The diagnosis is often delayed due to the generalised nature of the symptoms on presentation, and a high index of suspicion is therefore required of the surgical team. Based on our experience of gallstone ileus and a review of the literature, we believe that simple enterolithotomy is the optimal treatment for this condition, especially in elderly or comorbid patients.

Keywords: Bowel; enterolithotomy; gallstone; ileus; obstruction