Abstract
Gallstone ileus is a rare entity which develops in only 0.3 to 0.5% of
patients with cholelithiasis
Gallstone sigmoid ileus is very rare manifestation of the large bowel
obstruction. Mainly, three conditions predispose the manifestation of
the entity; in particular, an episode of cholecystitis causing
cholecysto-colonic fistula; a large gallstone; and narrowing of the
sigmoid colon secondary to diverticular disease or malignancy [1].
An 82-year old man presented to the emergency department with one-week
history of severe constipation, tachypnoea, tachycardia, hypotension and
high lactate. Physical examination demonstrated cyanosed upper and lower
extremities; palpation of the abdomen revealed signs of peritonism,
abdominal distention and guarding. CT scan demonstrated perforation of
the hollow viscus organ secondary to impaction of the large gallstone in
the sigmoid colon [Figure 1]. Laparotomy revealed sigmoid
perforation and widespread feculent peritonitis. Patient underwent
Hartmann’s procedure. After the intervention given concerns regarding
patient’s haemodynamic stability, he transferred in the intensive care
unit. Patient passed away in the third postoperative day due to
complications secondary to haemodynamic instability.
Patients with early diagnosed uncomplicated sigmoid gallstone ileus can
be managed with endoscopic mechanical lithotripsy. In case of failure
open or laparoscopic enterolithotomy can be applied. However, when
patients presented with complications surgery should not be delayed