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Case Report
Delayed presentation of gallstone ileus due to spilled gallstones: A case report
1 MBChB, General Surgical Registrar, North Shore Hospital, Auckland, New Zealand
2 MBBS, MSc, General Surgical Registrar, Monash Health, Victoria, Australia
3 MBChB, Radiology Registrar, North Shore Hospital, Auckland, New Zealand
4 MBBS, FRACS, General Surgical and Colorectal Fellow, Monash Health, Victoria, Australia
Address correspondence to:
Binura Buwaneka Wijesinghe Lekamalage
MBChB, General Surgical Registrar, North Shore Hospital, Auckland,
New Zealand
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Article ID: 100126Z12BL2023
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Lekamalage BBW, Thaveenthiran P, Ghate KN, Arachchi A. Delayed presentation of gallstone ileus due to spilled gallstones: A case report. J Case Rep Images Surg 2023;9(2):27–31.ABSTRACT
Introduction: Gallstone ileus is a rare cause of intestinal obstruction and very few cases have been reported of spilled gallstones during a cholecystectomy resulting in a delayed presentation of gallstone ileus. Although complications from unretrieved gallstones are rare, there is a variety of post-operative complications described in the literature. Most complications occur within the first few months but can occur up to 10 years after the procedure. If complications arise, they may lead to significant morbidity and management may result in an invasive intervention, including a laparotomy.
Case Report: An 83-year-old female underwent laparoscopic cholecystectomy for acute cholecystitis, during which several large gallstones spilled and an attempt at retrieval was made. Six years later, she presented to the emergency department with a small bowel obstruction due to gallstone ileus caused by an unretrieved spilled gallstone. She underwent laparotomy, and the gallstone was retrieved from the terminal ileum.
Conclusion: Gallstone ileus can occur because of unretrieved spilled gallstones from a cholecystectomy. Although complications from unretrieved gallstones are rare, this case report highlights the importance of considering this as a differential diagnosis when patients present with symptoms consistent with intestinal obstruction after a cholecystectomy. It is important to attempt to retrieve spilled gallstones during cholecystectomy, but if this is not feasible, this should be documented, and patients should be informed of the potential risks of unretrieved stones although rare.
Keywords: Gallstone, Gallstone ileus, Laparoscopic cholecystectomy
SUPPORTING INFORMATION
Author Contributions
Binura Buwaneka Wijesinghe Lekamalage - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Prasanthan Thaveenthiran - Revising it critically for important intellectual content, Final approval of the version to be published
Kaustubha Nikhil Ghate - Drafting the article, Final approval of the version to be published
Asiri Arachchi - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Binura Buwaneka Wijesinghe Lekamalage et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
