Title: Diagnosis and treatment of Gallstone ileus with Cholangitis and Cholecysto-enteric fistula in an Elderly Female
Authors: Rasmirekha Behera, Sushant Kumar Sethi
DOI: http://dx.doi.org/10.18535/jmscr/v4i5.19
A 88yr old female known case of diabetes, hypertension and CKD presented with fever and Chills for 15 days with yellowish discolouration of sclera and urine for 5 days. On evaluation she was found to have evidence of Calculus Cholecystitis, Choledocholithiasis and Cholangitis. Patient was managed with IV fluid, IV antibiotics and other supportive treatment. ERCP was planned. After CBD Cannulation with Sphincterotomy and ballon sweeping, Pus, fragmented stones and black bile came out. After multiple ballon sweeping and clearing CBD plastic stent was placed.Patient was discharged as she was asymptomatic after 7 days. Removal of GB was deferred as patient's family denied the same. However after 15days she presented with recurrent vomiting and abdominal distension. CT abdomen revealed large Cholecysto-enteric fistula and Calculus within mid small bowel suggestive of gall stone ileus. Exploratory laparotomy with enterostomy was done. Investigations-Sonography, CT abdomen, LFT Diagnosis-Cholangitis, Cholecysto-enteric Fistula and Gall stone ileus Management-ERCP, Stenting,Surgery (Exploratory laparotomy with enterostomy) Key words-Cholecysto-enteric fistula, Gall stone ileus, Cholangitis 1. Reisner RM and Cohen JR(1994)Gallstone ileus:a review of 1001 reported cases.Am Surg 60:441-446. 2. Halabi WJ,Kang CY,Ketana N,et al.Surgery for gallstone ileus: a nationwide comparison of trends and outcomes.Ann Surg 2014;259:329. 3. Ayantunde AA,Agrawal A.Gallstone ileus:diagnosis and management. World J Surg 2007;31:1292. 4. Chatterjee S,Tamonas C,Goutan G,Ambar G:Gallstone ileus an atypical presentation and unusual location.Int J Surj 2008,6(6):e55-e56. 5. Chen-Wang C,Shou-Chuan S,Shee-Chau L,Cheng-Hsin C:Gall stone ileus: a disease easily ignored in the elderly. Int J Gastenterology 2008,2(1):18-21. 6. Longo DL,Fauci AS,Kasper DL,Hauser SL,Jameson JL,Loscalzo J.Chapter 311,Diseases of the Gallbladder and Bile Ducts.In: Longo DL,Fauci AS,Kasper DL,Hauser SL,Jameson JL,Loscalzo J,eds.Harrison's Principles of Internal Medicine.18th ed.NewYork :Mc Graw-Hill;2012. 7. Gurvits GE,Lan G;Enterolithiasis.World J Gastroenterol.2014 Dec 21;20(47):17819-29. 8. Farooq A,Memon B,Memon MA; Resolution of gallstone ileus with spontaneous evaluation of gallstone.Emerg Radiol.2007 Nov;14(6):421-3. 9. Qamrul Arfin SM,Haqqi SA,Shaikh H,et al; Bouveret's syndrome :successful endoscopic treatment of gastric outlet obstruction caused by an impacted gallstone.J Coll Physicians Surg Pak.2012 Mar;22(3):174-5. 10. Ishikura H,Sakata A,kimura S,Okitsu H,et al:Gall stone ileus of the Colon.Surgery 2005,138:3. 11. De Palma GD,Mastrobuni G,Benassai G:Endoscopic removal of a gall stone obstructing the lower ileum.Dig Liv Dis 2009,41(6):446. 12. Williams JB,Mehta SG,Vu T,Wonderlich D A:Gallstone ileus.The journal of emergency medicine. doi: 10.1016/J.Jmer.11.063. 13. Masanat Y,Massanat Y,Shatnawel A.Gallstone ileus :a review.Mt Sinai J Med.2006;73:1132-4. 14. Gan S,Roy Choudhury S,Agrawal S,et al;More than meets the eye:subtle but important CT findings in Bouveret's syndrome.AJR Am J Roentgenol.2008 Jul;191(1):182-5. 15. Yu CY,Lin CC,Shyu RY,Hsieh CB,Wu HS,et al.Value of CT in diagnosis and management of gallstone ileus.World J Gastroenterol.2005;11:2142-7. 16. Sackmann M,Holl J,Haerlin M,Saucroruch T,Hoermann R,et al.Gallstone ileus successfully treated by shockwave lithotripsy.Dig Dis Sci.1991;36:1794-5. 17. Soto D,Evan SJ,Kavic MS.Laproscopic management of gallstone ileus.J Soc Laparosc Surg.2001;5:279-85. 18. Franklin Jr ME,Dorman JP,Schuessler WW.Laparoscopic treatment of gallstone ileus:a case report and review of the literature.J Laparoendosc Surg:4:265-72. 19. Warshaw AL,Bartlett MK,Choice of operation for gallstone intenstinal obstruction.Ann Surg.1966;164:1051-5. 20. Fraser WJ.Intenstinal obstruction by gallstone.Br J Surg.1954;42:210. 21. Welch JS,Huizenga KA,Roberts SE. Recurrent intenstinal obstruction due to gall stones.Proc Staff Meet Mayo Clinic. 1957;32:628.Abstract
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