Muhammad Zaheer, Faisal Murad, Muhammed Younus, Asif Zafar Malik.
Gallstone Ileus.
J Rawal Med Coll Jan ;9(1):39-40.

A sixty-seven-year old lady, known patient of hypertension (HTN) and ischemic heart disease (IHD) for the last four years, presented with the classical signs and symptoms of small bowel obstruction for 5 days. One-year back she suffered an attack of acute calculus cholecystitis. Interval cholecystectomy was planned which was postponed several times because of her cardiac problem. Considering the cardiac status and absence of indications for immediate exploration, the patient was managed conservatively by intravenous infusions and suction. Obstruction relieved spontaneously and the patient was allowed oral fluids. She remained hospitalized for unstable cardiac status. She suffered recurrent attacks of abdominal pain during this period. However she opened her bowel regularly. Her abdominal ultrasound was repeated, which showed contracted gall bladder containing sludge. Details could not be evaluated. On the 7th day of admission, she again developed acute intestinal obstruction. Exploratory laparotomy through midline incision was carried out. The small bowel was found obstructed due to impacted gallstone lying 20cm proximal to Ileocecal junction. There was a mass in the right hypochondrium comprising of gallbladder fundus adherent to first part of duodenum and omentum. Enterolithotomy was performed. The postoperative recovery was uneventful.

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