Presentation
Abdominal pain with hypotension
Patient Data
Age: 80 years
Gender: Female
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Pertinent findings:
- 32mm calcified gallstone within the lumen of the small bowel
- Discrete choledocholithiasis fistula
- Multiple loops of dilated small bowel measuring up to 3.8cm in diameter
- Some of the small bowel demonstrate mural thickening and hypoenhancement and is associated with adjacent inflammatory fat stranding
- Intramural gas within the small bowel immediately proximal to the gallstone
- Free fluid in pelvis
- No free gas
- Previous right mastectomy
Conclusion:
- Gallstone ileus, with ischemic changes of the small bowel immediately proximal to the gallstone
Case Discussion
This 80-year old frail and co-morbid lady presented from a nursing home. She had a history of biliary colic, and presented with gallstone ileus and small bowel compromise.
Definitive treatment would include a small bowel resection and entero-lithotomy. However, patient was not a surgical candidate given her elderly, frail baseline and high peri-operative risk. The decision was made to palliate the patient.
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