Gallstone Ileus Associated with Synchronous Carcinoid Strictures of the Small Bowel
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ORIGINAL RESEARCH
Gallstone Ileus Associated with Synchronous Carcinoid Strictures of the Small Bowel Muhammad Hanif Shiwani & Christopher G. Whitfield & Andrew Hill & Quat Ullah
Published online: 15 April 2010 # Springer Science+Business Media, LLC 2010
Abstract Introduction Gallstone ileus and synchronous two carcinoids of small bowel, both pathologies have no known pathological reasons to be associated with each other and are not known to be together in one patient. Case Report We present a case of a 72-year-old lady who presented with small bowel obstruction as an emergency. At laparotomy we found gall stones entrapped between two carcinoid strictures in ileum. Segmental small bowel resection was performed without disturbing the biliary pathology. Conclusion Association of these two pathologies in a single patient causing small bowel obstruction has never been reported. Importance of a thorough laparotomy is emphasized. Keywords carcinoid . gallstone ileus . small bowel obstruction
Introduction Gallstone ileus is intestinal obstruction secondary to luminal occlusion by an ectopic gallstone. Carcinoid tumors are neoplasms of neuroendocrine origin with variable malignant potential. Association of these pathologies in a single patients contributing to the small bowel obstruction has never been reported.
M. H. Shiwani (*) : C. G. Whitfield : A. Hill : Q. Ullah Barnsley General Hospital, Barnsley, UK e-mail: [email protected]
Report A 72-year-old female presented as an emergency with 2-week history of central colicky abdominal pain, feculent vomiting, and constipation. She was known to have a solitary gallstone. Clinically she was not toxic. Her abdomen was soft but distended. Her WBC was 12.9× 109/l and normal renal and liver biochemistry. A plain abdominal X-ray showed dilated loops of small bowel. CT scanning of the abdomen confirmed small bowel obstruction and also showed an abrupt transition point in the terminal ileum. Additionally, gas was observed in the common bile duct and intrahepatic ducts (Fig. 1). This was consistent with gallstone ileus though the gallstone was not seen. At laparotomy small bowel obstruction was confirmed. A 2.5-cm gallstone was seen to be lodged in the mid-ileum. In this region, two strictures were noted, between which the progress of the gallstone had been arrested. A 20-cm segmental wedge resection of involved small bowel was performed with primary anastomosis. The biliary tree was not disturbed as it can increase the morbidity. Recovery was delayed by a superficial wound dehiscence, treated with antibiotics and application of a vacuum-assisted dressing. The resected specimen revealed the presence of two stenoses, each consists of 10-mm yellow-white nodule confining the gallstone. Microscopically, the nodules comprised of islands and trabeculae of cells of uniform appearance, scanty eosinophilic cytoplasm and vesicular nuclei with a ‘salt and pepper’ chromatin pattern. Each neoplasm had breached the submucosa and muscularis mucosa, reaching the serosa. The appearance was conf
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