Perforated Closed-Loop Obstruction Secondary to Gallstone Ileus of the Transverse Colon: A Rare Entity

Abstract EN

Introduction.

Gallstone ileus (GSI) of the colon is an extremely rare entity with potentially serious complications including perforation.

Case Presentation.

An 88-year-old man presented to the emergency department with abdominal pain and distension.

Clinical exam revealed signs of peritonism.

Computed tomography (CT) revealed GSI of the transverse colon with a closed-loop large bowel obstruction (LBO) and caecal perforation.

The patient underwent emergency laparotomy.

A right hemicolectomy was performed, the gallstone was removed, and a primary bowel anastomosis was undertaken.

A Foley catheter was sutured into the residual gallbladder bed to create a controlled biliary fistula.

The patient recovered well postoperatively with no complications.

He was discharged home with the Foley catheter in situ.

Discussion.

Gallstone ileus is a difficult diagnosis both clinically and radiologically with only 50% of cases being diagnosed preoperatively.

Most commonly it is associated with impaction at the ileocaecal valve and small bowel obstruction.

Gallstone ileus should also be considered as a rare but potential cause of LBO.

This is the first reported case of caecal perforation secondary to gallstone ileus of the transverse colon.

Successful operative management consisted of a one-stage procedure with right hemicolectomy and formation of a controlled biliary fistula.