A Case of Descending Colon Diverticulitis with Perforation Caused by Gallstone Ileus

Abstract

A 74-year-old woman who had been treated for descending colon diverticulitis 2 months earlier was admitted to our hospital because of a one-day history of left lower abdominal pain and vomiting. Abdominal computed tomography revealed descending colon diverticulitis and gallstone in the duodenum, suggesting gallstone ileus. The gallstone spontaneously passed into the descending colon and abdominal symptoms improved conservatively, however, fever up and left lower abdominal pain occurred when she started to take meal. Computed tomography revealed free air around the descending colon, suggesting perforation caused by the impacted gallstone. Emergency operation was performed 13 days after admission. Laparotomy disclosed perforation of the descending colon at the site of gallstone. Descending colectomy and loop ileostomy were performed. The resected specimen showed stenosis and perforation of the descending colon due to diverticulitis. It is etiologically inferred that the gallstone had impacted into the stenosed lumen of the descending colon due to diverticulitis that might cause perforation. Gallstone ileus is a rare disease and few cases have been reported on intestinal perforation caused by gallstone ileus.