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Gallstone Ileus : Clinical Features

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CLINICAL FEATURES: The presentation of gallstone ileus is non-specific. The symptoms wax and wane due to intermittent obstruction, delaying the diagnosis in more than half of the cases. Presenting symptoms include cramping abdominal pain, bloating, nausea, vomiting, loss of appetite, and constipation. Symptoms of acute cholecystitis are present only in a minority of patients, but 50% have a history of gallstones.

CASE HISTORY: The patient was a 60 y/o female who presented with history of colicky abdominal pain and bilious vomiting for two days and abdominal distension for one day. The onset was insidious but the frequency and intensity of these symptoms had increased over the last 6 months.

A plain film of abdomen showed 3 radio-opacities in the pelvic region. CT pelvis (see image 1) showed 3 radiodense bodies in the loops of ileum, the largest measuring 4.2 cm in diameter. The small bowel loops were distended. There was no pneumobilia.

She underwent exploratory laparotomy and a 20 cm segment of ileum containing the three large gallstones was resected. Cross section of the stones revealed concentric yellow-brown laminations (see next image), consistent with mixed stones.

Case courtesy of: Dr. Sanjay D. Deshmukh (Professor of Pathology), Dr. Jayant M. Gadekar (Chief of Surgery), and Dr. Priyanka Ingole (Senior Resident in Pathology), Dr. Vithalrao Vikhe Patil Foundation's Medical College and Hospitals, Ahmednagar, India.

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