Sarosh Majid, Sabeen Arif, Asma Naseer Cheema and Anwar Ul Haque
Department of Pathology, Azad Jammu & Kashmir Medical College, AJK University Muzaffarabad
Abstract: Gallstone ileus has been rarely reported and typically related to older age (>65years), the case described
here is of biliary ileus in a 33years old patient. The right hemicolectomy specimen was sent for histopathology
examination from Sheikh Khalifa Bin Zayed Hospital (SKBZH) after exploratory laparotomy. On opening, a
pigmented stone of mulberry type measuring 3.2x2x1.3cm was found impacted at ileocecal junction on cecal side.
Microscopic examination revealed intact mucosal lining with normal morphology and distribution of colonic
glands. There was fibrosis in the wall of area surrounding the stone. Mild inflammation was present in the mucosa
along with serosal congestion. Margins were healthy and no proof of carcinoid tumor or malignancy was appreciated.
The case was traced retrospectively and patient was called to seek the formation of stone in this unusual place.
Detailed history, examination was done and investigation reports were observed. A diagnosis of biliary ileus was
made. It was concluded that large stone was formed as a consequence of accretion of multiple small stones dropped
from gall bladder through a fistula. Furthermore, the small stones bound each other as a result of chemical reaction
catalyzed by the enzymes of that region.
Keywords: Cecal tumor, biliary ileus, Gallstone, Cholecystitis, Cholecystocolonic fistula