To leave no stone unturned: cholelithiasis and subsequent gallstone ileus

Description

A 68-year-old man was admitted after a sudden collapse and a 5-day history of severe vomiting. On admission, he was hypotensive with a blood pressure of 70/60 mm Hg and had to be fluid resuscitated with 3 L of intravenous fluids via a femoral venous catheter. A nasogastric tube was inserted and 1600 mLs of brown vomitus aspirated. Venous blood gas showed a lactate of 5 mmol/L. The patient was in acute renal failure with urea of 30 mmol/L and creatinine of 224 μmol/L. On surgical review, he was not thought to be clinically obstructed and an abdominal radiograph showed some sentinel loops but otherwise did not reveal any obvious bowel dilation (figure 1). The patient had had a CT scan a month earlier when he had been staged for newly diagnosed prostate cancer; the scan had visualised a calcified circular opacity with a laminated appearance consistent with a gallstone in the...

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