Gorgan C^1,2, Baboi D^1,2, Costache D^3,4 and Draghici L^1,2*

¹“Carol Davila” University of Medicine and Pharmacy Bucharest, Romania
²General Surgery Clinic of “Sf Ioan” Clinical Emergency Hospital Bucharest, Romania
³The University of Pitesti, Romania
⁴The Radiology and Medical Imaging Department of Pediatric Hospital Pitești, Romania

*Corresponding Author: Draghici L, “Carol Davila” University of Medicine and Pharmacy Bucharest, Romania.

Received: December 15, 2023; Published: January 09, 2024

Abstract

Introduction: Gallstone ileus is a rare and severe complication of cholelithiasis, that results in small bowel obstruction and surgical treatment represents the elective therapeutical method. The decision of applying the laparoscopic technique is strongly influenced by the accuracy of the diagnosis and the preoperative objectivation of the pathogenic mechanism.

Case Presentation: 70-year old male, with a known history of over 30 years of biliary microlithiasis, with one gallstone (Ø ≈ 40-50 mm), came to hospital with the symptomatology of high intestinal obstruction. The ultrasound exam revealed a gallbladder with extremely thickened walls, without being able to confirm cholelithiasis. The surgeon relied on the patient’s biliary history and requested emergency computed tomography with the administration of contrast agent. The scan raised the suspicion of gallstone ileus, but could not fully confirm the existence of the Rigler triad (hypodense ectopic calculus hard to identify). The upper digestive endoscopy that completed the imaging investigations came to confirm the diagnosis by visualization and video exploration of the cholecystic-duodenal fistula. Full laparoscopic surgery was performed immediately and the patient’s postoperative evolution was good, without complications.

Conclusions: Even if it represents a pathological entity rarely seen in practice, gallstone ileus must be taken into consideration in the differential diagnosis of small bowel obstruction and the pathogenic mechanism can be successfully objectivated before surgery through appropriate clinical and paraclinical correlations. 

Keywords: Gallstone Ileus; CT Scan; Pathology

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Citation

Citation: Draghici L., et al. “The Pathogenic Mechanism of Gallstone Ileus, Rarely Objectivated Preoperatively, Through Clinical, Imaging and Videoendoscopic Correlations – A Clinical Case Presentation”.Acta Scientific Medical Sciences 8.2 (2024): 02-09.

Copyright

Copyright: © 2024 Draghici L., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.