Two Cases of Gallstone Ileus

Abstract

We report herein on two cases of gallstone ileus. Patient 1: A 65-year-old woman visited our hospital because of nausea. Abdominal computed tomography revealed a pigeon egg-sized, stone-like foreign body in the distal ileum, causing intestinal obstruction. Gallstone ileus was suspected, and treated conservatively. Seven days after admission, the stone was evacuated in feces. Because subsequent radiological gastrointestinal series, endoscopy, and MRCP showed cholecysto-duodenal fistula, the patient was finally diagnosed as having gallstone ileus. Patient 2：An 85-year-old man was referred to our hospital complaining of vomiting and lower abdominal pain. A large gallbladder stone was identified, and abdominal computed tomography revealed an incarcerated pigeon egg-sized gall stone at the horizontal duodenum with disappearance of the gallbladder stone. Endoscopy showed a spherical gallstone which was incarcerated at the horizontal duodenum. An attempt to remove the stone via an endoscopic technique was unsuccessful. The patient was diagnosed as having gallstone ileus, and was treated conservatively. The stone in the horizontal duodenum was propelled to the distal small intestine 7 days after admission. Because the stone was stuck in the mid ileum on the 11th post-admission day, the patient underwent lithotomy by incising the ileum via a small laparotomy. He was discharged from the hospital on the 26th postoperative day. Although the the stone in these two cases was almost identical, one needed an operation and other did not.