Unusual complications of gallstones – Case 2

8th June 2023.

Came across this interesting case earlier this year. Elderly patient with a history of known gallstone disease. Presented with a week history of abdominal pain and abdominal distention. He also felt nauseated and vomited numerous times.  On examination, his abdomen was grossly distended and generally tender.

A CT scan of the abdomen was ordered and it showed a large gallstone causing obstruction in the distal small bowel (CT scan image).  Medical textbooks describe this condition as gallstone ileus.

As we know, gallstones is prevalent in 20% of the population.  Occasionally, large gallstones can cause pressure on the gallbladder wall against nearby structures.  In this instant, the gallstone eroded through the gallbladder into the duodenum.  The gallstone then migrated in the small intestine and unfortunately got stuck in the distal small bowel causing the obstruction.

Patient underwent emergency surgery on the very same day. Intraoperatively, it was found that part of the small bowel was perforated due to the obstruction.  The large stone (as shown in the picture) was retrieved and the bowel perforation was repaired.  If this was not treated promptly, the patient would have severe sepsis and this can be fatal. The patient eventually recovered well and was able to return home.

Gallstone disease is a common condition.  Important to speak to a specialist surgeon to discuss treatment options. Gallstones causing abdominal pains and bloated symptoms are often misdiagnosed  as other conditions.

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