Skip to main content
SpringerLink
Log in

Laparoscopic Management of a Proximal Jejunal Gallstone Ileus with Patulous Ampulla and Choledochal Cyst—a Report of Unusual Presentation and a Review

  • Review Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

Gallstone ileus is a diagnosis of rarity, and a proximal site of obstruction in a young patient is even rare. Of the three cases in our experience, we found two cases of gallstone ileus (GSI) with typical epidemiology and presentation, one had combination of multiple rare associations. We report such a case, suspected to have gallstone ileus on ultrasound and confirmed diagnosis on computed tomography. Presence of biliary-enteric fistula, old age, and obstructive features, as in typical cases, was a bigger asset for diagnosis, but it was difficult to entertain diagnosis of GSI in young girl in absence of a demonstrable biliary-enteric fistula, with uncommon association of choledochal cyst and sickle cell disease. A very surprising finding, dilated major papilla, could however explain the pathogenesis which has also been reported in the past. Although differential opinions regarding management exist, we decided to follow two-stage surgery as our institute protocol. A minimal access approach has been immensely helpful in accurate diagnosis, and expedative management with early recovery has been proven in the past studies which we agreed with our experience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Spaziani E, Picchio M, Di Filippo A, De Angelis F, Marino G, Stagnitti F (2010) Gallstone ileus. Report of two cases. Ann Ital Chir 81(1):53–55

    PubMed  Google Scholar 

  2. Gaiani S, Serra C, Cervellera M, Campione O, Bolondi L, Miglioli M (2000) Gallstone ileus in Caroli’s disease. Am J Gastroenterol 95(12):3642–3643

    Article  CAS  PubMed  Google Scholar 

  3. Gupta M, Goyal SLS, Singal R, Goyal R, Goyal SLS, Mittal A (2010) Gallstone ileus and jejunal perforation along with gangrenous bowel in a young patient: a case report. N Am J Med Sci 2(9):442–443

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dai X-Z, Li G-Q, Zhang F, Wang X-H, Zhang C-Y (2013) Gallstone ileus: case report and literature review. World J Gastroenterol 19(33):5586–5589

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chou J-W, Hsu C-H, Liao K-F, Lai H-C, Cheng K-S, Peng C-Y et al (2007) Gallstone ileus: report of two cases and review of the literature. World J Gastroenterol 13(8):1295–1298

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tucker A, Garstin I (2013) A peculiar cause of bowel obstruction. Int J Surg Case Rep 4(5):473–476

  7. Toelen C, Huyghe M (2012) Gallstone ileus in a patient with Crohn’s disease: a case report. Acta Chir Belg 112(5):390–392

    Article  CAS  PubMed  Google Scholar 

  8. Reports C, Giese A, Zieren J, Winnekendonk G, Henning BF (2010) Development of a duodenal gallstone ileus with gastric outlet obstruction (Bouveret syndrome) four months after successful treatment of symptomatic gallstone disease with cholecystitis and cholangitis: a case report. J Med Case Rep 4(1):376

    Article  Google Scholar 

  9. Casella R, Müller W (1992) Gallstone ileus—still a current disease. Schweiz Rundsch Med Prax 81(20):654–660

    CAS  PubMed  Google Scholar 

  10. Halabi WJ, Kang CY, Ketana N, Lafaro KJ, Nguyen VQ, Stamos MJ et al (2014) Surgery for gallstone ileus: a nationwide comparison of trends and outcomes. Ann Surg 259(2):329–335

    Article  PubMed  Google Scholar 

  11. He J, Xu K, Tang J (2010) Intestinal obstruction caused by gallstone: report of 5 cases and review of the literature. Zhonghua Wei Chang Wai Ke Za Zhi 13(10):751–754

    PubMed  Google Scholar 

  12. Chatterjee S, Chaudhuri T, Ghosh G, Ganguly A (2008) Gallstone ileus—an atypical presentation and unusual location. Int J Surg 6(6):e55–e56

    Article  PubMed  Google Scholar 

  13. Cooperman AM, Dickson ER, ReMine WH (1968) Changing concepts in the surgical treatment of gallstone ileus: a review of 15 cases with emphasis on diagnosis and treatment. Ann Surg 167(3):377–383

  14. Rojas-Rojas DJA, Martínez-Ordaz JL, Romero-Hernández T (2012) Biliary ileus: 10-year experience. Case series. Cir Cir 80(3):228–232

    PubMed  Google Scholar 

  15. Vaughan-Shaw PG, Talwar A (2013) Gallstone ileus and fatal gallstone coleus: the importance of the second stone. BMJ Case Rep. doi:10.1136/bcr-2012-008008

  16. Beuran M, Ivanov I, Venter MD (2010) Gallstone ileus—clinical and therapeutic aspects. J Med Life. 3(4):365–371

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Chang CW, Shih SC, Lin SC, Chu CH, Wang TE, Chang WH (2008) Gallstone ileus: a disease easily ignored in the elderly. Int J Gerontol 2(1):18–21

    Article  Google Scholar 

  18. Jian-song JI, Si-zheng Z, Chu-xiao S, Zhong-wei Z, Zu-fei W, Gui-jian LÜ, et al. (2014) Imaging diagnosis of two unusual forms of gallstone ileus. (10):29–31.

  19. Martín-Pérez J, Delgado-Plasencia L, Bravo-Gutiérrez A, Burillo-Putze G, Martínez-Riera A, Alarcó-Hernández A et al (2013) Gallstone ileus as a cause of acute abdomen. Importance of early diagnosis for surgical treatment. Cirugía española 91(8):485–489

    Article  PubMed  Google Scholar 

  20. Zens T, Liebl RS (2010) Gallstone ileus 30 years status postcholecystectomy. 109(6):332–335

  21. Mondragón Sánchez A, Berrones Stringel G, Tort Martínez A, Soberanes Fernández C, Domínguez Camacho L, Mondragón SR (2005) Surgical management of gallstone ileus: fourteen year experience. Rev Gastroenterol México 70(1):44–49

    Google Scholar 

  22. Anseline P (1981) Colonic gall-stone ileus. Postgrad Med J 57(663):62–65

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Szajnbock I, Lorenzi F, Rodrigues Júnior a J, Zantut LF, Poggetti RS, Steinman E, et al. Gallstone ileus as a cause of upper intestinal obstruction. Sao Paulo Med J 1996;114(4):1239–1243.

  24. Turner GGA (1932) Giant gall-stone impacted in the colon and causing acute obstruction. Br J Surg. 20(77):26–33

    Article  Google Scholar 

  25. Langhorst J, Schumacher B, Deselaers T, Neuhaus H (2000) Successful endoscopic therapy of a gastric outlet obstruction due to a gallstone with intracorporeal laser lithotripsy: a case of Bouveret’s syndrome. Gastrointest Endosc 51(2):209–213

    Article  CAS  PubMed  Google Scholar 

  26. Ozbalci GS, Tanrikulu Y, Kismet K, Dinc S, Akkus MA (2012) Gallstone ileus with a giant stone and associated multiple stones. Bratisl Lek Listy 113(8):503–505

  27. Reisner RM, Cohen JR (1994) Gallstone ileus: a review of 1001 reported cases. Am Surg 60(6):441–446

    CAS  PubMed  Google Scholar 

  28. Swinnen L, Sainte T (1994) Colonic gallstone ileus. J Belg Radiol 77(6):272–274

    CAS  PubMed  Google Scholar 

  29. Donati M, Cardì F, Brancato G, Calò P, Donati A (2010) The surgical treatment of a rare complication: gallstone ileus. Ann Ital Chir 81(1):57–62

    PubMed  Google Scholar 

  30. Ball WR, Elshaieb M, Hershman MJ (2013) Rectosigmoid gallstone coleus: a rare emergency presentation. BMJ Case Rep. doi:10.1136/bcr-2013-201136

  31. Toelen C, Huyghe M. (2012) Gallstone Ileus in a patient with crohn’s disease: a case report. Acta Chir Belg 112(5):390–392

  32. Sun R, Theilmann L, Vöhringer U, Abdel Samie A (2010) Gallstone ileus in underlying stenosis of the sigmoid due to recurrent diverticulitis—a rare complication of cholelithiasis. Med Klin (Munich) 105(6):433–436

    Article  Google Scholar 

  33. Ayeni I V, Williams NJ (2012) An unusual cause of a non-functioning stoma in an 87-year-old gentleman. BMJ Case Rep. doi:10.1136/bcr-03-2012-6008

  34. Ivanov I, Beuran M, Venter MD, Iftimie-Nastase I, Smarandache R, Popescu B et al (2012) Gallstone ileus after laparoscopic cholecystectomy. J Med Life 5(3):335–341

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Micheletto G, Danelli P, Morandi A, Panizzo V, Montorsi M (2013) Gallstone ileus after biliointestinal bypass: report of two cases. J Gastrointest Surg 17(12):2162–2165

    Article  PubMed  Google Scholar 

  36. Aslam J, Patel P, Odogwu S (2014) A case of recurrent gallstone ileus: the fate of the residual gallstone remains unknown. BMJ Case Rep. doi:10.1136/bcr-2013-203345

  37. Gandamihardja TAK, Kibria SMG (2014) Recurrent gallstone ileus: beware of the faceted stone. BMJ Case Rep. doi:10.1136/bcr-2014-205795.

  38. Webb LH, Ott MM, Gunter OL (2010) Once bitten, twice incised: recurrent gallstone ileus. Am J Surg 200(6):e72–e74

    Article  PubMed  Google Scholar 

  39. Armitage G, Fowweather FS, Johnstone AS (1950) Observations on bile-acid enteroliths with an account of a recent case. Br J Surg 38(149):21–25

    Article  CAS  PubMed  Google Scholar 

  40. Freitag M, Elsner I, Günl U, Albert W, Ludwig K (1998) Clinical and imaging aspects of gallstone ileus. Experiences with 108 individual observations. Chirurg 69(3):265–269

    Article  CAS  PubMed  Google Scholar 

  41. Hildebrandt J, Herrmann U, Diettrich H (1990) Gallstone ileus. A report of 104 cases. Chirurg 61(5):392–395

    CAS  PubMed  Google Scholar 

  42. Halleran DR, Halleran DR (2014) Colonic perforation by a large gallstone: a rare case report. Int J Surg Case Rep 5(12):1295–1298

  43. C-Y Y, Lin C-C, Shyu R-Y, Hsieh C-B, H-S W, Tyan Y-S et al (2005) Value of CT in the diagnosis and management of gallstone ileus. World J Gastroenterol 11(14):2142–2147

    Article  Google Scholar 

  44. Zhao J, Barrera E, Salabat M, Denham W, Leung D, Ujiki M (2013) Endoscopic treatment for Bouveret syndrome. Surg Endosc 27(2):655

    Article  PubMed  Google Scholar 

  45. Shin KH, Kim DU, Choi MG, Kim WJ, Ryu DY, Lee BE et al (2011) A case of gallstone ileus treated with electrohydraulic lithotripsy guided by colonoscopy. Korean J Gastroenterol 57(2):125–128

    Article  PubMed  Google Scholar 

  46. Heinzow HS, Meister T, Wessling J, Domschke W, Ullerich H (2010) Ileal gallstone obstruction: single-balloon enteroscopic removal. 2(9):321–324

  47. Kim YG, Byeon J-S, Lee SK, Yang D-H, Kim K-J, Ye BD et al (2011) Gallstone ileus successfully treated with endoscopic fragmentation by using double-balloon endoscopy (with video). Gastrointest Endosc 74(1):228–230

    Article  PubMed  Google Scholar 

  48. Muratori R, Cennamo V, Menna M, Cecinato P, Eusebi LH, Mazzella G et al (2012) Colonic gallstone ileus treated with radiologically guided extracorporeal shock wave lithotripsy followed by endoscopic extraction. Endoscopy 44(Suppl 2):E88–E89

    PubMed  Google Scholar 

  49. Mallipeddi MK, Pappas TN, Shapiro ML, Scarborough JE (2013) Gallstone ileus: revisiting surgical outcomes using National Surgical Quality Improvement Program data. J Surg Res 184(1):84–88

    Article  PubMed  Google Scholar 

  50. Lujan HJ, Bisland WB (2010) Two-stage minimally invasive surgical management of colonic gallstone ileus. Surg Laparosc Endosc Percutan Tech 20(4):269–272

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Gastroenterology, Global Hospital, Lakdi Ka Pul, Hyderabad, 500004, India

    Rajvilas Anil Narkhede, Vijaykumar C. Bada & Lakshmi Kumari Kona

  2. Shemba, Nandura, Buldana, Maharashtra, 440103, India

    Rajvilas Anil Narkhede

Authors
  1. Rajvilas Anil Narkhede
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vijaykumar C. Bada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lakshmi Kumari Kona
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rajvilas Anil Narkhede.

Ethics declarations

Disclosure

The corresponding author is not a recipient of research fellowship.

The paper is not based on a previous communication to any society or meeting.

This case report was presented as a free poster in IASG 2015 held in Pune.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Method

The review is prepared by searching the following terms in Google scholar, Pubmed, and Pubmed central and exploring the related articles popped on the side of a page. The terms were gallstone ileus, bilio-enteric fistula, Bouveret syndrome, jejunal obstruction.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Narkhede, R.A., Bada, V.C. & Kona, L. Laparoscopic Management of a Proximal Jejunal Gallstone Ileus with Patulous Ampulla and Choledochal Cyst—a Report of Unusual Presentation and a Review. Indian J Surg 79, 51–57 (2017). https://doi.org/10.1007/s12262-016-1575-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-016-1575-x

Keywords

Search

Navigation