ACUTE GALLSTONE OBSTRUCTION OF THE LARGE- BOWEL

Gallstone ileus is an unusual cause of mechanical obstruction of the g astrointestinal tract; but obstruction of the colon by a gallstone is an even more rare event, and there are few references in the literatur e. We describe the cases of two elderly women who were admitted to the Emergency Service with a mechanical obstruction of the colon and air in the biliary tract. A barium-enema examination showed the presence o f a foreign body in the sigmoid colon; this was found to be a gallston e in a subsequent colonoscopy in one of the patients; a precise preope rative diagnosis was not possible in the other. In both cases the obst ruction was caused by a gallstone impacted in the sigmoid colon and a cholecystocolic fistula was evident in a postoperative barium enema ex amination. Correction of the obstruction is the main objective of init ial treatment. The repair of the fistula can be performed at the same time or at a later date.