A CASE OF GALLSTONE ILEUS WITH COMPLETE FOLLOW-UP OF THE CLINICAL COURSE FROM INTRAGASTRIC EXCRETION OF THE INTACYSTIC STONE TO ONSET

Gallstone ileus is a relatively rare complication of cholelithiasis. This paper reports a peculiar case of gallstone ileus in which a gallstone entering the stomach through an internal biliary fistula was well recognized by chance upon X-ray films in an upper GI series.A 55-year-old woman presented with dull obdominal pain. She underwent various examinations in an outpatient department and a gallstone was revealed by ultrasonography. Subsequent X-ray studies of the upper GI tract demonstrated a transparent shadow approximately 25 mm in diameter in the stomach. The shadow was considered to correspond to a gallstone which had passed into the stomach. Symptoms due to ileus appeared thereafter, and on admission laparotomy was performed under a diagnosis of gallstone ileus. A gallstone the size of a small hen's egg was found impacted in the small bowel about 100 cm orad from the terminal ileum. The stone was removed via an intestinal transverse incision and then suitable surgical treatments for the biliary and upper GI tracts were added. Postoperative course was uneventful. Paradoxically, in this case, it is considered that premedication for an upper GI series (intramuscular injection of Coliopan and atropine sulfate) could have acted to some extent in inducing the expulsion of the gallstone through a cholecystoprepyloric fistula.