Gallstone Obstruction In Jejunum: A Rare Case

Abstract

Gallstone ileus refers to mechanical obstruction of the small intestine due to impaction of one or more gallstones. It occurs as a complication of cholelithiasis, more in elderly females [1]. CECT is the best diagnostic tool and the definitive treatment of gallstone ileus is surgical removal. The prevalence of cholelithiasis among American Indians may reach upto 70% and is much lower in Asians[6]. However most cases of cholelithiasis are asymptomatic and are found as an incidental finding and it is reported that on an average 1-2.3% of patients experience complications[8]. Gallstone ileus occurs due to inflammation and erosion of any part of the biliary tree leading to enterobiliary fistula through which the stone passes. Patients usually present with non-specific symptoms and acute cholecystitis is present in 10–30% cases[9]. Diagnosis clinically poses a challenge due to vague presentation with nonspecific symptoms but a radiological diagnosis on CECT and MRCP can be made. Enterolithotomy is a definitive procedure with or without cholecystectomy, fistula closure. The ongoing inflammation may complicate cholecystectomy and fistula repair. Considering that most patients are older with multiple comorbidities with added physiological stress, multiple procedures are not done in the same setting. Though laparoscopic/ laparoscopy assisted surgeries have reported better efficiency and lesser complications, less availability of equipment and surgeon’s skills and training are often a limiting factor. As there are variabilities in the surgical approaches the patient factors and surgeon factors must be kept well in mind and then to proceed with the surgery of choice. With all these at the back of the mind, higher success rates with lesser hospital stay, perioperative events and mortalities are achievable.