Title: Diagnosis and treatment of Gallstone ileus with Cholangitis and Cholecysto-enteric fistula in an Elderly Female
Authors: Rasmirekha Behera, Sushant Kumar Sethi
DOI: http://dx.doi.org/10.18535/jmscr/v4i5.19
Abstract
A 88yr old female known case of diabetes, hypertension and CKD presented with fever and Chills for 15 days with yellowish discolouration of sclera and urine for 5 days. On evaluation she was found to have evidence of Calculus Cholecystitis, Choledocholithiasis and Cholangitis. Patient was managed with IV fluid, IV antibiotics and other supportive treatment. ERCP was planned. After CBD Cannulation with Sphincterotomy and ballon sweeping, Pus, fragmented stones and black bile came out. After multiple ballon sweeping and clearing CBD plastic stent was placed.Patient was discharged as she was asymptomatic after 7 days. Removal of GB was deferred as patient's family denied the same. However after 15days she presented with recurrent vomiting and abdominal distension. CT abdomen revealed large Cholecysto-enteric fistula and Calculus within mid small bowel suggestive of gall stone ileus. Exploratory laparotomy with enterostomy was done.
Investigations-Sonography, CT abdomen, LFT
Diagnosis-Cholangitis, Cholecysto-enteric Fistula and Gall stone ileus
Management-ERCP, Stenting,Surgery (Exploratory laparotomy with enterostomy)
Key words-Cholecysto-enteric fistula, Gall stone ileus, Cholangitis
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