Gallstone ileus presenting as intussusception

Abstract

BACKGROUND: Gallstone ileus is a complication of acute cholecystitis that accounts for 25% of bowel obstruction cases in the elderly. To our knowledge, only one other case of gallstone ileus presenting as intussusception has been reported in the literature, and involved non-operative management with an unfavorable outcome. CASE PRESENTATION: Here we report the case of 69year old woman presenting with symptoms of acute small bowel obstruction with a surgical history significant for cholecystectomy 30 years prior. Computed tomographic imaging showed a target sign in the small bowel consistent with intussusception, but intraoperative diagnosis revealed this to be a gallstone. A simple enterolithotomy was conducted and the patient has since been symptom free. DISCUSSION: Gallstone ileus has a high mortality rate (12-17%) and is an important differential diagnosis to consider, especially as the elderly population throughout the world continues to grow. CONCLUSION: As radiographic features of gallstones are variable we suggest maintaining a high index of suspicion for gallstone ileus in any elderly patient presenting with SBO, even with a seemingly contradictory surgical history.