Unusual complication of gallstone: perforated appendicitis due to gallstone

Abstract

Gallstone disease is a rare problem affecting the digestive system which may cause some important complications such as acute cholecystitis, choledocholithiasis, cholangitis, jaundice, gallstone pancreatitis, cholecystoenteric fistula leading to obstruction of the intestine (gallstone ileus) and gallbladder carcinoma. A 30-year old man presented to emergency department with abdominal pain, nausea and bilious vomiting. Physical examination, laboratory findings and imaging studies were suggestive of an acute gallstone appendicitis. Laparoscopy revealed a 1.1 cm gallstone at the base of the appendix, leading to perforated appendicitis. The case was successfully managed by laparoscopic appendectomy with retrieval of the gallstone. There was no demonstrable cholelithiasis or biliaiy-intestinal fistula. No surgery was undertaken for the gallbladder. Diagnosis was confirmed by biochemical analysis of the stone, which contained cholesterol and calcium bilirubinate. Acute appendicitis is a rare presentations of a gallstone in the gastrointestinal tract. Computed tomography is crucial in reaching the correct diagnosis. Laparoscopic appendectomy which also allows further exploration of the gallbladder and bile duct is a safe and adequate surgical procedure.