Adv Pediatr Surg.  2022 Jun;28(1):21-25. 10.13029/aps.2022.28.1.21.

Surgically Treated Gallstone Ileus 22 Years After Kasai Portoenterostomy: A Case Report

• Gang S
• Youn JK
• Kim HY

• KMID: 2538285
• DOI: http://doi.org/10.13029/aps.2022.28.1.21

Abstract

Gallstone ileus occurs when there is a fistula between the gallbladder and the small intestine, by which the gallstone reaches the small bowel and thereby inducing bowel obstruction. This condition is very rare in the overall population, accounting for only 0.1–5%. It is also very rare in the pediatric population and in the patients who undergo Kasai operation as well. Worldwide, only two cases have been reported. Gallstone production may be facilitated under certain circumstances, and migrated stone induces ileus. Diagnosis is usually done by imaging studies such as abdominal ultrasonography and computed tomogram (CT). Surgical removal of stone is decisive treatment. The 22-year-old female patient with a history of Kasai operation at age of 1 month visited emergency department for abdominal pain. The most reasonable impression was the acute exacerbation of the chronic cholangitis, but it was improved soon after intravenous antibiotics treatment. At the same time, mechanical ileus was diagnosed and exacerbated during admission. CT was done to find out the cause. Small bowel obstruction by a round material was observed. By considering its clinical course and the imaging, the material was suspected to be gallstone. The patient underwent enterolithotomy under general anesthesia. She was fully recovered from gallstone ileus after stone removal. There has been no recurrence of ileus nor cholangitis. When a patient with a history of Kasai portoenterostomy complains mechanical ileus, the clinician need to allow for gallstone ileus referring patient’s history and medical condition which promotes to induce stone formation.

Keyword

Ileus; Portoenterostomy; Biliary atresia; Intestinal obstruction