An unforgettable concurrence: Successfully managed gallstone ileus accompanied by diabetic nephropathy
A 60-year-old male presented with vomiting and abdominal pain, which had lasted for two days, in Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, India in March, 2011. Patient had been previously treated in a private hospital for intestinal obstruction using Ryle's tube aspiration, intravenous fluids, and antibiotics. He had also been kept orally nil for about 1 week, but there was no relief. There was also a history of old brain infarcts and he was a known diabetic on regular treatment. Abdominal examination revealed only tenderness on the right side while the rest of the abdomen was soft and bowel sounds were present. On blood tests, elevated total leukocyte counts (15,500 /cu mm), blood urea (96 mg/dl), and creatinine (2.6 mg/dl) were observed. Erect skiagram and ultrasound showed dilated loops of the small bowel. On contrast enhanced computed tomography (CECT), there was a stone/stricture/obstruction in distal part of the ileum along with air in the gallbladder. Diagnosis was made as intestinal obstruction with septicemia on basis of clinical and radiological correlations.\nIn view of acute intestinal obstruction, laparotomy was performed and findings revealed proximal dilated loops without any collection in the peritoneum. A large stone of 4 cm in size was present one foot proximal to ileocaecal junction and was causing obstruction (). The gallstone was removed through the perforation site after milking and strictureplasty were conducted (Figure and ). On gross examination, the stone was oval in shape, hard in nature, brownish in color, and 5 cm in size (Figure and ). The patient is recouping well post-operatively.