Gallstone Enteropathy: An Unusual Cause of Bowel Obstruction.

Gallstones causing bowel obstruction, known as gallstone ileus, are rare and account for less than 0.5% of small bowel obstruction cases. Additionally, it is a rare complication affecting only 0.3% of patients who have gallstones. Fistula formation between the biliary system, most commonly between the gallbladder and duodenum because of their proximity, facilitates the migration of gallstones into the enteric system with subsequent impaction in the small intestine, usually in the distal ileum close to the ileocecal valve, promoting the development of mechanical small bowel obstruction. Computerized tomography of the abdomen and pelvis is a confirmatory and widely used imaging study when there are two signs of Rigler's triad, which includes pneumobilia, evidence of small bowel obstruction and the presence of radiopaque stones. We report a case of a 75-year-old Caucasian man who presented with abdominal distention with signs of severe dehydration secondary to intractable nausea and vomiting complicated with severe acute kidney injury and was found to have a 4.7-centimeter gallstone-induced small intestinal obstruction.

Radiological Diagnosis and Surgical Treatment of Gallstone Ileus.

We report on the diagnosis and treatment of a patient who presented with a small bowel obstruction due to gallstone ileus. This condition is an infrequent complication of cholelithiasis that presents with non-specific and intermittent findings, including bloating, early satiety, constipation, nausea, and vomiting. Contrast-enhanced CT features the classic imaging finding, called Rigler's triad, which includes small bowel distension, gas in the gallbladder, and an ectopic gallstone. Laparoscopic enterolithotomy is employed to prevent further erosion through the gallbladder wall and into the adjacent gastrointestinal structures. The early diagnosis and treatment of gallstone ileus results in decreased morbidity and mortality.

Colonic Gallstone Ileus: Treatment Challenges.

Intestinal obstruction at the level of the colon is rarely caused by a gallstone. Colonic gallstone is more frequently observed in elderly patients and is associated with high mortality due to treatment challenges. Management with less invasive approaches, including mechanical lithotripsy and endoscopy has been evolving. However, the outcomes are variable, and surgery remains the main cornerstone of treatment. We present a case of an 89-year-old male with gallstone ileus at the level of the sigmoid colon in whom treatment with endoscopy was not successful. We performed an extensive review of the literature to understand the most common presentation, diagnostic modalities, and treatment approach of the sporadic reported cases of colonic gallstone ileus.