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Image of the Month—Diagnosis
Arch Surg. 2006;141:610.
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Answer: Enterolithotomy
A midline laparotomy was performed, a dilated proximal small intestine was found, and a large gallstone was identified in the proximal jejunum with dilated bowel proximal to the point of impaction. An enterolithotomy was performed by making a longitudinal enterotomy proximal to point of the impaction, milking the gallstone proximally and removing it. Subsequently, the enterotomy was closed in a transverse fashion and the bowel was run to ensure that there were no other gallstones in the remainder of the small intestine. The abdomen was closed without performing cholecystectomy.
Gallstone ileus is a rare complication of cholelithiasis occurring in approximately 0.5% of patients. The average age of patients who develop gallstone ileus is 70 years, and women are affected 3 to 16 times more often than men. The gallstone ileus develops from pericholecystic inflammation after cholecystitis, which in turn leads to an adhesion between the biliary and enteric systems. Next, . . . [Full Text of this Article]
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Image of the Month—Quiz Case
Min P. Kim, Yael Vin, and Sareh Parangi
Arch Surg. 2006;141(6):609.
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