The symptoms of Crohn's disease can vary significantly among afflicted individuals. It is a chronic inflammatory disease, which has many complications involving gastrointestinal and other symptoms. The diagnosis of gallstone ileus is difficult in Crohn's disease and an early diagnosis can reduce mortality. We present a case of 72 year old female with known Crohn's disease with acute right iliac fossa pain. She was investigated with an abdominal CT, giving a definite diagnosis of gallstone ileus

EV Loftus

KW Heaton

Mehwish Qureshi

Rashaad Gossiel

Sheharyar Asif Qureshi

English

PubMed

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RETRACTED ARTICLE: Gallstone ileus an unusual reason for right iliac fossa pain in Crohn's disease: a case report

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Cases Journal
Case Report
Gallstone ileus an unusual reason for right iliac fossa pain in
Crohn’s disease: a case report
Sheharyar Asif Qureshi*1, Rashaad Gossiel2 and Mehwish Qureshi3
Addresses: 1Department of Acute Medicine, Queens Medical Centre, Nottingham University Hospitals, Derby Road, Nottingham, UK,
2Emergency Admissions Unit, Lincoln County Hospital, United Lincolnshire NHS Trust, Greetwell Road, Lincoln, UK and 3Department of
Psychiatry, Birmingham Children Hospital, Birmingham and Heartlands NHS Trust, Birmingham, UK
E-mail: Sheharyar Asif Qureshi* - drsheharyarasif@gmail.com; Rashaad Gossiel - rashaad.gossiel@ulh.nhs.uk;
Mehwish Qureshi - drmehwish@gmail.com
*Corresponding author
Published: 4 December 2009 Received: 5 February 2009
Cases Journal 2009, 2:9142 doi: 10.1186/1757-1626-2-9142 Accepted: 4 December 2009
This article is available from: http://www.casesjournal.com/content/2/1/9142
© 2009 Qureshi et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
The symptoms of Crohn’s disease can vary significantly among afflicted individuals. It is a chronic
inflammatory disease, which has many complications involving gastrointestinal and other symptoms.
The diagnosis of gallstone ileus is difficult in Crohn’s disease and an early diagnosis can reduce
mortality. We present a case of 72 year old female with known Crohn’s disease with acute right iliac
fossa pain. She was investigated with an abdominal CT, giving a definite diagnosis of gallstone ileus.
Introduction
Crohn’s disease is an inflammatory disease, which may
effect any part of the digestive system. The main
symptoms are abdominal pain, diarrhea, vomiting and
weight loss. Abdominal pain may be an initial symptom
of Crohn’s disease.
Ileocolic Crohn’s disease effects the ileum and large
intestine accounts of 50 percent of the cases [1].
Gallstone ileus is a rare complication of Crohn’s disease.
It accounts for 1-4% of all bowel obstructions. Gallstone
ileus should always be in the differential diagnosis, when
elderly patients are assessed for abdominal pain.
Case presentation
We present a case of 74-year-old Caucasian women
complaining of colicky abdominal pain on admission.
She reported acute onset of right iliac fossa pain for 24
hours with associated vomiting but no other associated
bowel symptoms. She reported past medical history of
hypertension, recent myocardial infarction and Crohn’s
disease in remission. Her Crohn’s was under remission
for last ten years without any current treatment. There
was no previous history of abdominal surgery. She was
non smoker and drank alcohol socially. She was taking
no regular medications.
On visual survey, she suffered with no stigmata of a
chronic disease. On inspection there were no scars over
the abdomen. Her abdominal examination on palpation
revealed tenderness in right iliac fossa and loin but no
guarding or rigidity. Percussion and auscultation of
abdomen was unremarkable. Other systemic examina-
tion was normal. Her routine haematology and bio-
chemistry were normal. Her abdominal x-ray revealed a
calcification in right iliac fossa (Figure 1).
The CT scan of the abdomen revealed a gall stone in the
small bowel lumen with no signs of bowel obstruction.
The bowel wall showed some proximal edema to the gall
stone (Figure 2, Figure 3, Figure 4, Figure 5, Figure 6,
Figure 7, Figure 8 and Figure 9).
She was treated with conservative measures including
pain relief and intravenous fluid rehydration. An
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Figure 1
X ray of the abdomen showing calcification in right
iliac fossa.
Figure 2
The CT scan of the abdomen showing gall stone in
the small bowel lumen with no signs of bowel
obstruction. The bowel wall showing proximal edema to
the gall stone.
Figure 4
Further CT scan of the abdomen showing gall stone
in the small bowel lumen with no signs of bowel
obstruction. The bowel wall showing proximal edema to
the gall stone.
Figure 3
Further CT scan of the abdomen showing gall stone
in the small bowel lumen with no signs of bowel
obstruction. The bowel wall showing proximal edema to
the gall stone.
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Figure 5
Further CT scan of the abdomen showing gall stone
in the small bowel lumen with no signs of bowel
obstruction. The bowel wall showing proximal edema to
the gall stone.
Figure 6
Further CT scan of the abdomen showing gall stone
in the small bowel lumen with no signs of bowel
obstruction. The bowel wall showing proximal edema to
the gall stone.
Figure 7
Further CT scan of the abdomen showing gall stone
in the small bowel lumen with no signs of bowel
obstruction. The bowel wall showing proximal edema to
the gall stone.
Figure 8
Further CT scan of the abdomen showing gall stone
in the small bowel lumen with no signs of bowel
obstruction. The bowel wall showing proximal edema to
the gall stone.
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exploratory supraumbilical laprotomy was performed
which revealed impacted gall stone just proximal to the
ileocolic junction. She achieved an uneventful recovery
and discharged after 5 days of her surgery.
Conclusion
Crohn’s disease is chronic bowel disease, which can lead
to several mechanical complications within the intestine.
Obstruction typically occurs with strictures and adhe-
sions. The increased prevalence of gall stones in Crohn’s
disease is thought to be related to depletion of bile salt
pool due to terminal ileal disease [2]. Gallstone ileus is a
common surgical emergency in older females. It presents
during acute medical takes and a delay in achieving
diagnosis is not uncommon. If it is left untreated it leads
to increased mortality. A high index of suspicion in older
patients with intermittent gastrointestinal symptoms
should trigger appropriate sensitive investigation like
computed tomography of the abdomen.
Consent
Written informed consent was obtained from the patient
for publication of this case report and accompanying
images. A copy of the written consent is available for
review by the Editor-in-Chief of this journal.
Competing interests
The authors declare that they have no competing
interests.
Authors’ contributions
SQ collected the data and drafted the manuscript with
help from MQ. RG provided the supervision for writing
the manuscript. All authors read and approved the
manuscript.
References
1. Loftus EV, Schoenfeld P and Standborn WJ: The epidemiology and
natural history of Crohn’s disease in population based
patient cohorts from North America: a systemic review’.
Aliment Pharmacol Ther 2002, 16(1):51–60.
2. Heaton KW and Read AE: Gall stones in patients with disorders
of terminal ileum and disturbed bile salt metabolism. Br Med
J 1969, 3(5669):494–496.
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Figure 9
Further CT scan of the abdomen showing gall stone
in the small bowel lumen with no signs of bowel
obstruction. The bowel wall showing proximal edema to
the gall stone.
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Read AE: Gall stones in patients with disorders of terminal ileum and disturbed bile salt metabolism. Br Med J

The epidemiology and natural history of Crohn’s disease in population based patient cohorts from North America: a systemic review. Aliment Pharmacol Ther

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2827046

Gallstone ileus an unusual reason for right iliac fossa pain in Crohn's disease: a case report

Gallstone ileus an unusual reason for right iliac fossa pain in Crohn's disease: a case report

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