Tarar Roma, Rahman Anishur
New York Institute of Technology College of Osteopathic Medicine, 100 Northern Blvd Glen Head, Old Westbury, NY 11542, USA.
UHS Wilson Medical Center, 33-57 Harrison St, Johnson City, NY 13790, USA.
Radiol Case Rep. 2025 Aug 22;20(11):5668-5675. doi: 10.1016/j.radcr.2025.07.060. eCollection 2025 Nov.
Gallstone ileus, a rare complication of cholecystitis, occurs when the distal ileum becomes obstructed by gallstone causing, mechanical bowel obstruction. Gallstone ileus with history of cholecystectomy is exceptionally rare, with few cases documented in literature. This case report details the discovery of a large, impacted gallstone 16 years postcholecystectomy. An 87-year-old male presented with progressively worsening right-sided abdominal pain over 2-3 days. Exploratory laparotomy unveiled a 2.0 cm × 2.5 cm gallstone was obstructing the terminal ileum. Patient improved remarkably postoperatively and was discharged with resolution of symptoms. A potential cause for this large gallstone impaction within the terminal ileum is gallstone ileus, which can be explained with history of intentional or unintentional subtotal cholecystectomy or long cystic duct remnant. Both rare occurrences that allow gallstone formation or passage through a chronic cholecystoduodenal fistula due to inflammatory changes. With increasing trend toward subtotal cholecystectomies and division of cystic duct closer to the gallbladder neck, this case could potentially be explained as a gallstone ileus, despite extended postoperative intervals.
胆石性肠梗阻是胆囊炎的一种罕见并发症，当远端回肠被胆结石阻塞导致机械性肠梗阻时发生。有胆囊切除术史的胆石性肠梗阻极为罕见，文献中记载的病例很少。本病例报告详细描述了胆囊切除术后16年发现的一枚巨大嵌顿胆结石。一名87岁男性在2至3天内出现右侧腹痛逐渐加重。剖腹探查发现一枚2.0厘米×2.5厘米的胆结石阻塞了回肠末端。患者术后明显好转，症状缓解后出院。回肠末端出现这种巨大胆结石嵌顿的一个潜在原因是胆石性肠梗阻，这可以用有意或无意的次全胆囊切除术史或长胆囊管残端来解释。这两种罕见情况都因炎症变化而导致胆结石形成或通过慢性胆囊十二指肠瘘管。随着次全胆囊切除术以及在更靠近胆囊颈部处切断胆囊管的趋势增加，尽管术后间隔时间较长，本病例仍可能被解释为胆石性肠梗阻。
