A Case of Gallstone Ileus after Gastrectomy and Cholecystectomy

Mai Ohta, Masayuki Shiobara, Katsuhiko Ando, Masao Nunomura, Hiromi Sarashina and Masaru Miyazaki*

Department of Surgery, Chiba Aoba Municipal Hospital
Department of General Surgery, Chiba University Graduate School of Medicine*

We reported a case of gallstone ileus with a history of gastrectomy with Billroth-II reconstruction 23 years earlier and of cholecystectomy 3 years earlier. A 69-year-old man admitted for upper abdominal pain was found in abdominal computed tomography to have a high-density mass in the upper jejunum, confirmed by abdominal ultrasonography showing a mass with an acoustic shadow in the upper abdomen. We treated him with nasogastric suction based on a diagnosis of occlusive ileus caused by the food mass. Two days later, abdominal ultrasonography showed that the mass had migrated to the left lower abdomen, where we diagnosed a gallstone lodged in the ileum, and the gallstone removed through an enterotomy. The stone consisted of a bilirubin calcium core and uncertain surface elements. The man had no history of jaundice, biliary-enteric fistula, or pneumobilia, so we suspect that a choledocholith might have passed via Vater's papilla and grown in the afferent loop. Nine cases of gallstone ileus after cholecystectomy have been reported in the Japanese literature and 5 cases in the English.

Key words
gallstone ileus, absence of gallbladder, after gastrectomy

Reprint requests
Mai Ohta Department of General Surgery, Chiba University Graduate School of Medicine
1-8-1 Inohana, Chuo-ku, Chiba, 260-8677 JAPAN

Accepted
March 26, 2008

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