Auburn Research Day 2022

Cl i n i ca l Case Repor t | Med i ca l St udent Gallstone Ileus: A Case Report 21

(1) Fahad K. Uddin, OMS-III; (2) Dr. Lorenzo Sampson, MD, FACS (1) Edward Via College of Osteopathic Medicine-Auburn; (2) Aiken Regional Medical Center in Aiken, South Carolina

Gallstone ileus is a rare complication of cholecystitis in which a gallstone dislodges from the gallbladder and obstructs the small intestine. It presents with the typical signs of a small bowel obstruction, but if overlooked, could lead to life-threatening health consequences such as bowel perforation, sepsis, or death. This case discusses a 73-year-old-male who presented to the emergency department with weakness and associated vomiting. He admitted to not having a bowel movement for several days as he was not eating anything due to his sickness. The patient was diagnosed with pneumonia after routine chest x-ray, which warranted admission, however, on chest CT, it was noted that the patient had an incidental finding of distended bowel loops and pneumobilia, which led to further investigation and discovery of a 4.3 x 2.9cm calcified mass in the distal ileum consistent with a gallstone. As his hospital course progressed, he was noted to develop signs of

a small bowel obstruction, such as right lower quadrant abdominal tenderness and decreased bowel sounds. A successful laparotomy and enterotomy was carried out to retrieve the gallstone but due to the chronic inflammation of the gallbladder, the organ adhered itself to the duodenum. A decision was made to leave the organ and cholecystoduodenal fistula patient and a plan was made to follow up with an esophagogastroduodenoscopy to monitor the area. Patient had minor wound complications as noted in the discussion section of this case report, but overall recovered well from the procedure. This case highlighted the importance of identifying gallstone ileus as this pathology is rare and has a high mortality rate if left untreated. The goal of this clinical case report is to discuss the pathogenesis of this pathology and how it presents in a clinical setting, including key physical and radiologic findings.

Courtney Baldwin, VCOM-Auburn; Dr. Joshua Day, MD, Princeton Baptist Medical Center; Dr. Gregory Bearden, MD, Princeton Baptist Medical Center VCOM-Auburn; Princeton Baptist Medical Center 22 Cl i n i ca l Case Repor t | Med i ca l St udent Rare Case of Appendicitis

Two common operations for general surgeons are appendectomies and herniorrhaphies. However, the indication for both surgeries concurrently is much rarer. An Amyand hernia is a type of inguinal hernia in which the appendix has herniated within the hernial sac. Amyand hernias account for 1% of inguinal hernias and only 0.1% present with appendicitis. A 70-year-old African-American man presented to the emergency room because of worsening right lower quadrant pain, nausea and vomiting. His labs revealed leukocytosis (14,000 WBC/microL). The physical exam showed a large, right groin bulge that was nonreducible. The diagnosis of an inguinal hernia was made after the physical exam. His abdominal CT revealed an appendiceal perforation without abscess. An Amyand hernia was diagnosed from the CT image and an emergency open appendectomy with a primary right herniorrhaphy was performed. During the operation, the appendix was confirmed to be perforated near the base with minimal contamination in the hernia sac. The appendix and hernia sac were transected. The patient’s post-op complication included an ileus that was resolved post-op day 6.

This case demonstrates the importance of a thorough physical exam and maintaining a high degree of suspicion for appendiceal perforation. The patient was operated on swiftly and the perforated appendix had minimal leakage that was contained within the hernia sac. Recognizing appendicitis is imperative in preventing severe abdominal sepsis, a potentially fatal complication in Amyand hernias with a mortality rate of 14-30%.

17 2022 Via Research Recognit ion Day