1. Gallstone ileus in a patient with amyotrophic lateral sclerosis: A case report
- Author
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Vincent Marcucci, Derick Christian, and Sindi Diko
- Subjects
medicine.medical_specialty ,Exploratory laparotomy ,medicine.medical_treatment ,Population ,Gallstone ileus ,03 medical and health sciences ,0302 clinical medicine ,ALS, Amyotrophic Lateral Sclerosis ,Case report ,Medicine ,Enterolithotomy ,Amyotrophic lateral sclerosis ,education ,POD, post-operative day ,education.field_of_study ,GI, gallstone ileus ,Gastric emptying ,business.industry ,Gallstones ,medicine.disease ,Cholecystoduodenal fistula ,digestive system diseases ,Surgery ,CT, computed tomography ,Bowel obstruction ,NGT, nasogastric tube ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business ,Rare disease ,WBC, white blood cell ,ERCP, endoscopic retrograde cholangiopancreatography - Abstract
Highlights • Gallstone ileus is an uncommon complication of untreated cholelithiasis affecting an aged population. • Amyotrophic lateral sclerosis has documented dysautonomia causing significant delays in colonic transit times and gastric emptying. • Intestinal hypoperistalsis and adrenergic hyperfunctioning may be related to impaired gallbladder contractility resulting in sludge and stone accumulation. • We present a unique case of gallstone ileus in a patient with amyotrophic lateral sclerosis., Introduction and importance Gallstone ileus is a rare disease that most commonly occurs in elderly females with a history of cholelithiasis. It has not been previously associated with Amyotrophic Lateral Sclerosis (ALS); a neurodegenerative disease that primarily affects the motor neurons at the spinal and bulbar levels. Autonomic malfunction, in particular, gastrointestinal dysfunction has been documented in ALS patients which may predispose this population to the development of gallstones and gut dysmotility. Case presentation In this paper, we report a case of gallstone ileus in a patient with diagnosed ALS. We performed an exploratory laparotomy, enterolithotomy, and an open cholecystectomy with takedown/closure of a cholecystoduodenal fistula. The patient had a relatively uncomplicated postoperative course and was discharged from the hospital on postoperative day nine. Clinical discussion Delays in gastric emptying and colonic transit times in ALS patients may pose a risk for the development of gallstones and the potential impaction of a gallstone ileus in patients who are left untreated. Multifactorial evaluation of this patient population is necessary when assessing a potential causal pattern of gallstone ileus in patients with significant comorbidities. Conclusion We present an unusual pathology without an established incidence, which has pertinent multidisciplinary implications. The suspicion of ALS as a potential cause for the development of a gallstone ileus is relevant and essential in the diagnostic workup for an elderly patient who develops a small bowel obstruction with multi-comorbidities.
- Published
- 2021