Gallstone Ileus with Atypical Clinical Presentation: A Case Report

Authors

  • Alejandro Alberto Flores-López Clínica Hospital Mérida ISSSTE. Calle 21 Comisaría de Susulá, Mérida, Yucatán, México PC 97314 And General Hospital Playa del Carmen, Quintana Roo
  • Alicia Valeria Espinosa-Rosales Clínica Hospital Mérida ISSSTE. Calle 21 Comisaría de Susulá, Mérida, Yucatán, México PC 97314 And General Hospital Playa del Carmen, Quintana Roo
  • Luis Arturo Falcón-Cancino Clínica Hospital Mérida ISSSTE. Calle 21 Comisaría de Susulá, Mérida, Yucatán, México PC 97314 And General Hospital Playa del Carmen, Quintana Roo
  • Laura Daniela Caridad Carrillo-Pinto Clínica Hospital Mérida ISSSTE. Calle 21 Comisaría de Susulá, Mérida, Yucatán, México PC 97314 And General Hospital Playa del Carmen, Quintana Roo
  • Adriana Guadalupe Gómez-Salazar Clínica Hospital Mérida ISSSTE. Calle 21 Comisaría de Susulá, Mérida, Yucatán, México PC 97314 And General Hospital Playa del Carmen, Quintana Roo
  • Juan Ignacio Santana-Valencia Clínica Hospital Mérida ISSSTE. Calle 21 Comisaría de Susulá, Mérida, Yucatán, México PC 97314 And General Hospital Playa del Carmen, Quintana Roo
  • Vanessa Alejandra Quijano-Soberanis Clínica Hospital Mérida ISSSTE. Calle 21 Comisaría de Susulá, Mérida, Yucatán, México PC 97314 And General Hospital Playa del Carmen, Quintana Roo
  • Alejandro Lenin Villalobos-Rodríguez Clínica Hospital Mérida ISSSTE. Calle 21 Comisaría de Susulá, Mérida, Yucatán, México PC 97314 And General Hospital Playa del Carmen, Quintana Roo
  • Guillermo Padrón-Arredondo Clínica Hospital Mérida ISSSTE. Calle 21 Comisaría de Susulá, Mérida, Yucatán, México PC 97314 And General Hospital Playa del Carmen, Quintana Roo

DOI:

https://doi.org/10.14738/bjhmr.102.14248

Keywords:

Intestinal obstruction, Gallstone ileus, íleo biliary, cholelithiasis

Abstract

Introduction: Gallstone ileus is a rare complication of cholelithiasis, described as a mechanical intestinal obstruction due to the impaction of one or more large gallstones within the gastrointestinal tract. It is caused by the passage of a gallstone from the bile ducts into the intestinal lumen through a fistula. The most frequent type of fistula is located between the gallbladder and the duodenum. Clinical Case: A 60-year-old male was admitted with a diagnosis of DM 2 / hypovolemic shock / upper gastrointestinal bleeding. Began 24 h before admission, presented asthenia, adynamia, hyporexia, tolerating only a liquid diet, 3 vomits of gastric contents and one melenic evacuation. level of care for surveillance and diagnostic protocol, upon admission to this hospital he presented vomiting in coffee grounds and hypotension that responded to intravenous fluids. An exploratory laparotomy was performed, finding: obstruction of the small intestine by a gallstone of approximately 7 cm in diameter at 170 cm from the angle of Treitz, reactive appendicitis, and abundant inflammatory reaction fluid; Enterolithotomy + primary closure was performed with the Heineke-Mikulikcz technique and a Penrose drain was placed into the pelvic cavity. Discussion: Intestinal obstruction caused by gallstones is rare, this event occurs more frequently in the elderly. The clinical picture is often diffuse and requires a high index of suspicion. Conventional radiography can be of great help for its diagnosis, but also Abdominal Ultrasound and Computerized Axial Tomography. Surgical treatment can range from enterotomy and lithotomy, which is the simplest, to enterotomy with lithotomy plus cholecystectomy, and fistula treatment, which is a complex procedure.

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Published

2023-04-14

How to Cite

Flores-López, A. A., Espinosa-Rosales, A. V., Falcón-Cancino, L. A., Carrillo-Pinto, L. D. C., Gómez-Salazar, A. G., Santana-Valencia, J. I., Quijano-Soberanis, V. A., Villalobos-Rodríguez, A. L., & Padrón-Arredondo, G. (2023). Gallstone Ileus with Atypical Clinical Presentation: A Case Report. British Journal of Healthcare and Medical Research, 10(2), 254–260. https://doi.org/10.14738/bjhmr.102.14248

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