A RARE CAUSE OF SMALL BOWEL OBSTRUCTION: GALL STONE ILEUS – A RADIOLOGICAL CASE REPORT WITH REVIEW OF LITERATURE

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A. M. S. C. S. P. T. Bharat Jani, “A RARE CAUSE OF SMALL BOWEL OBSTRUCTION: GALL STONE ILEUS – A RADIOLOGICAL CASE REPORT WITH REVIEW OF LITERATURE”, ijmhs, vol. 8, no. 8, pp. 107–112, Aug. 2018.
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Abstract

Small bowel obstruction (SBO) is a common clinical condition. The effective management depends on an early and accurate diagnosis. Gall stone ileus is a rare cause of mechanical small bowel obstruction and contributes to 1-4% of all cases of mechanical small bowel obstruction. The incidence is typically seen in elderly females. The diagnosis is often difficult and a previous history of gall stone disease helps in reaching the correct diagnosis. Surgical management is the preferred modality for treatment. We are reporting a case of Gallstone ileus diagnosed recently in our hospital. A 54 year old elderly female presented with sudden onset abdominal pain with recurrent vomiting for one day. A  Plain radiograph of abdomen done in Emergency department suggested findings of small bowel obstruction. It was followed by an urgent ultrasound of abdomen which showed collapsed Gall bladder, pneumobilia and dilated non-peristaltic small bowel loops. Finally a contrast enhanced CT scan of abdomen was done and it showed air within in the biliary tree and within the collapsed Gall bladder. The Small bowel loops were dilated to the upper border of a large radiolucent intraluminal filling defect in the distal ileum. It also showed loss of clear interface between Gall bladder and second part of duodenum suggesting a possibility of Cholecystoenteric fistula. The patient underwent an urgent laparotomy with enterolithotomy. A 35 x 35mm calculus was impacted in the distal ileum. A fistulous communication was noticed between Gall bladder and the second part of duodenum which was repaired along with cholecystectomy.  

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