-Case Reports-

Response of Gallstone Ileus to Conservative Therapy

Toshimitsu Miyasaka¹, Hiroshi Yoshida¹, Hiroshi Makino¹, Manabu Watanabe², Eiichi Uchida² and Eiji Uchida³

¹Department of Surgery, Nippon Medical School Tama Nagayama Hospital
²Uchida Hospital
³Department of Surgery, Nippon Medical School

We report a case of cholelithiasis followed by gallstone ileus, documented with serial computed tomography (CT) scans, that responded to conservative therapy. An 80-year-old woman was admitted because of abdominal pain and vomiting. Six months previously, she had presented with abdominal pain and nausea of sudden onset. A CT scan showed thickening of the gallbladder wall and a gallbladder stone. She refused cholecystectomy, and the abdominal pain gradually improved in response to conservative treatment. On admission, plain abdominal radiographs showed obstruction of the proximal small bowel. A CT scan revealed disappearance of the gallbladder stone, fluid-filled bowel loops, and the presence in the small bowel of an impacted stone (major axis, 45 mm; minor axis, 23 mm). We diagnosed gallstone ileus. Because the gallstone was not large, we inserted a stomach tube and administered conservative treatment. One day after admission, CT showed that the impacted stone had migrated to the transverse colon. Four days after admission the impacted stone was not seen on plain abdominal radiography. Five days after admission, follow-up CT revealed pneumobilia but no impacted stone. Because the symptoms had improved the patient resumed oral intake of liquids The patient was discharged 14 days after admission and is doing well.

J Nippon Med Sch 2014; 81: 388-391

Keywords
gallstone ileus, computed tomography, choledocholithiasis

Correspondence to
Hiroshi Yoshida, MD, Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512, Japan
hiroshiy@nms.ac.jp

Received, February 24, 2014
Accepted, April 8, 2014