A CASE OF PREOPERATIVELY DIAGNOSED GALLSTONE ILEUS

Gallstone ileus is a relatively rare complication of cholelithiasis and it is hardly diagnosed preoperatively. This paper describes a such case in which we could successfully diagnosed preoperatively, together with a review of about 200 cases in the Japanese literature. A 66-year-old male was admitted because of a half-day history of abdominal pain with nausea on June 6, 1988. He had moderate leukocytosis and his abdomen was slightly distended with mild tenderness at the epigastrium. Abdominal plain X-ray films revealed a small bowel obstruction, air in the gallbladder and a oval-shaped calcificated mass of which position was changed daily on it. The upper G-I series showed a cholecystoduodenal fistula and an impacted gallstone in the terminal ileum. Laparotomy was carried out under a diagnosis of gallstone ileus 7 days after the admission. The impacted stone, measured 5×3×3cm, was milked back from the terminal ileum and was removed through enterotomy. Cholecystectomy and closure of the cholecystoduodenal fistula were performed. Postoperative course was uneventfull.