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We describe the case of an 81-year-old woman with large bowel-obstruction caused by an impacted gallstone. An 81-year-old, Caucasian, fully independent woman without significant comorbidities presented with absolute constipation, faecal vomiting and abdominal pain. Abdominal radiography revealed dilated small bowel, and a subsequent contrast CT demonstrated a 2.5 cm gallstone in the sigmoid colon. This is believed to have entered the transverse colon via a cholecyst-colonic fistula, and then migrated to a section of sigmoid colon affected by diverticular disease, where it became impacted. Two sigmoidoscopic removals were attempted but were unsuccessful as the gallstone's size prevented removal with an endoscopic basket. A laparotomy was performed and the stone extracted via a sigmoid enterotomy. No covering stoma was formed, and following 48 h on intensive trauma unit and a short ward-based stay for rehabilitation, the patient was discharged home and is currently doing well.

Original publication

DOI

10.1136/bcr-2014-208167

Type

Journal article

Journal

BMJ Case Rep

Publication Date

19/11/2014

Volume

2014

Keywords

Aged, 80 and over, Colon, Transverse, Colonic Diseases, Digestive System Surgical Procedures, Female, Gallstones, Humans, Intestinal Obstruction, Tomography, X-Ray Computed