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A Journal on Surgery

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Chirurgia 2012 June;25(3):201-3

language: English

An unusual cause of abdominal pain in a 90-year-old woman: gall stone ileus

Cesaretti M. 1, Longo G. 1, Tirone A. 2, Gaggelli I. 2, Trotta M. 1

1 DICMI, San Martino Hospital, University of Genoa, Genoa, Italy;
2 U.O.C. Chirurgia 2, AOU Senese, Siena, Italy


Gallstone ileus is a rare cause of mechanical intestinal obstruction. Usually it occurs in the elderly patients so it results in a high mortality rate due to the co-existing chronic disease. We reports a case of a 90-year-old woman that was admitted to the hospital for abdominal pain, vomiting, hyperpyrexia and constipation. Computer tomography imaging revealed dilated jejunal loops with gas-fluid levels, pneumobilia and an high density mass of 2,5 cm in diameter in the proximal ileum. We performed an emergent laparotomy with one-stage procedure with cholecystectomy, closure of the cholecysto-enteric fistula and enterolithotomy. The management of gallstone ileus remains controversial: conservative therapy, enterolithotomy, cholecystectomy and fistula repair as one-stage procedure or enterolothotomy at first and then cholecystectomy with fistula repair, were the treatments considered in literature. Patient was successfully treated by one-stage surgery because of the absence or important concomitant disease.

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