Gallstone Ileus Complicated by Small Intestinal Cancer: A Case Report

Abstract

An 88-year-old woman with a history of cholelithiasis was referred to our hospital with a history of abdominal pain and vomiting. Computed tomography (CT) revealed a 3.5-cm stone in the small intestine and a dilated intestinal segment on the oral side of the stone, but no stones in the gallbladder. Based on the findings, we made the diagnosis of gallstone ileus. An abdominal CT performed in the patient 3 years earlier had also revealed a stone in the small intestine, however, because of her advanced age and absence of symptoms, she had been followed up without treatment. Because spontaneous passage of the stone was considered unlikely, we performed emergency surgery. Intraoperatively, a 5-cm mass was found at a site approximately 50 cm from Bauhin’s valve, and partial small intestinal resection was performed. The resected small intestinal specimen was incised, and the impacted gallstone was removed. Following this, a depressed lesion was found on the small intestinal wall. Histopathological examination revealed primary small intestinal cancer with lymph node metastasis. Gallstone ileus complicated by small intestinal cancer is extremely rare. In such a case, it is assumed that stimulation by the prolonged presence of gallstones in the small intestine promotes carcinogenesis, followed by tumor growth. Thus, unless intestinal stones show spontaneous evacuation, they should be aggressively treated even in the absence of symptoms.