Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-92422

Sigmoid colon obstruction caused by a giant gallstone: A case report of successful endoscopic management

Güney Özkaya, Sangar Abdullah
Department Of General Surgery, Sancaktepe Þehit Prof. Dr. Ýlhan Varank Training And Research Hospital, Ýstanbul, Turkey

Mechanical bowel obstruction due to a giant colonic calculus is an exceedingly rare clinical entity, typically associated with gallstone ileus or migration through a cholecystocolonic fistula. This case report describes the clinical presentation, diagnostic process, and treatment of an 81-year-old male with a history of cholelithiasis who developed acute mechanical large bowel obstruction due to a 5 cm sigmoid colon calculus. The patient, with comorbidities including diabetes mellitus, hypertension, chronic renal failure, prior prostatectomy, and appendectomy, presented with abdominal pain, nausea, and vomiting. Physical examination revealed tenderness in the left lower quadrant without rebound or guarding, indicating no evidence of perforation. Laboratory findings showed leukocytosis (WBC: 12,000/μL, neutrophil percentage: 85.2%) and elevated CRP (33 mg/L). Non-contrast abdominal computed tomography (CT) revealed a 5 cm calculus in the sigmoid colon, with proximal dilatation, air-fluid levels, and pneumobilia. A prior hepatobiliary ultrasound had documented a 49 mm gallstone, suggesting migration via a cholecystocolonic fistula. Sigmoidoscopy, performed using an Olympus CF-HQ190 colonoscope with a tripod grasping forceps, successfully extracted the calculus. Due to the patient’s advanced age and significant comorbidities, surgical repair of the cholecystocolonic fistula was not pursued, and a follow-up hepatobiliary ultrasound one month post-procedure revealed no residual gallstones. The patient achieved rapid recovery and was discharged on following day. This case is notable for the exceptionally large 5 cm calculus, which is rare compared to the 2–3 cm stones typically reported, and highlights the efficacy of sigmoidoscopy in managing such cases in elderly patients with significant comorbidities.

Keywords: Sigmoid colon, gallstone ileus, giant calculus, sigmoidoscopy

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Dev safra taþýna baðlý sigmoid kolon týkanýklýðý: Endoskopik tedavi ile baþarýlý bir vaka

Güney Özkaya, Sangar Abdullah
Sancaktepe Þehit Prof. Dr. Ýlhan Varank Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Anabilim Dalý, Ýstanbul

Dev kolonik taþlara baðlý mekanik baðýrsak týkanýklýðý, genellikle safra taþý ileusuna veya kolesistokolonik fistül yoluyla taþýn migrasyonuna baðlý geliþen nadir bir klinik durumdur. Bu olgu sunumunda, 5 cm’lik sigmoid kolon taþýna baðlý akut mekanik baðýrsak týkanýklýðý geliþen kolelitiasis öyküsü olan 81 yaþýnda erkek bir hastanýn klinik bulgularý, taný süreci ve tedavisi ele alýndý. Diyabet, hipertansiyon, kronik böbrek yetmezliði, prostatektomi ve apendektomi öyküsü olan hasta, karýn aðrýsý, bulantý ve kusma þikayetleriyle baþvurdu. Fizik muayenede sol alt kadranda hassasiyet tespit edildi, ancak rebound veya defans olmamasý perforasyon olmadýðýný gösterdi. Laboratuvar bulgularý lökositoz (WBC: 12.000/μL, nötrofil yüzdesi: %85,2) ve yüksek CRP (33 mg/L) gösterdi. Kontrastsýz abdominal bilgisayarlý tomografide sigmoid kolonda 5 cm’lik bir taþ, kolonik dilatasyon, hava-sývý seviyeleri ve pnömobili tespit edildi. Önceki hepatobiliyer ultrasonografide 49 mm’lik bir safra taþý raporlanmýþtý, bu da taþýn kolesistokolonik fistül yoluyla migrasyonunu düþündürdü. Olympus CF-HQ190 kolonoskop ve tripod tutucu forseps kullanýlarak yapýlan sigmoidoskopi ile taþ baþarýlý bir þekilde çýkarýldý. Hastanýn ileri yaþý ve komorbiditeleri nedeniyle kolesistokolonik fistül onarýmý yapýlmadý; bir ay sonraki kontrol hepatobiliyer ultrasonografide taþ görülmedi. Hasta, giriþim sonrasý hýzlý iyileþme göstererek postoperatif birinci günde taburcu edildi. Bu olgu, literatürde genellikle 2-3 cm olarak bildirilen taþlara kýyasla 5 cm’lik nadir bir sigmoid kolon taþýnýn endoskopik olarak baþarýyla yönetildiðini göstermektedir. Sigmoidoskopi, komorbiditeleri olan yaþlý hastalarda bu tür olgularýn yönetiminde etkili bir yöntemdir.

Anahtar Kelimeler: Sigmoid kolon, safra taþý ileusu, dev kalkül, sigmoidoskopi

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