Roger S Taylor DO1, Nnennaya U Opara MD, MPH1, 2 , Taylor Simmerman DO11Emergency Medicine, Charleston Area Medical Center, Charleston, USA2Institute for Academic Medicine, Charleston, TX, USA Corresponding authors : Nnennaya U Opara, [email protected] Charleston Area Medical Centre 3200 MacCorkle drive.SE Charleston, WV 25304IntroductionAccording to the Centers for Disease Control and Prevention (CDC), cases of non-injury emergency department (ED) visits for which abdominal pain was the chief complaint increased by 31.8% from 2000 (5.3 million) to 2008 (7 million), constituting a 7.6% rise, and continue to increase [1]. Small bowel obstructions account for 2% of all patients presenting to the ED with abdominal pain [2] and may have many different etiologies, although the most common is tissue adhesions from previous abdominal surgeries, followed by hernias [3]. Herein, we present a case of abdominal pain secondary to a rare cause of bowel obstruction.Case presentationA 70-year-old Caucasian woman presented to the ED with the chief complaint of abdominal pain. Symptoms had started two days prior with intermittent dull abdominal pain, constipation, and dysuria. Over-the-counter laxatives seemed to alleviate constipation at that time; however, the other symptoms worsened, prompting the patient to meet with her primary care physician (PCP). She denied nausea or vomiting. The patient’s medical history was negative for surgery and she denied the use of tobacco, alcohol, or illicit drugs. Her family history was non-contributory. The PCP ordered a plain abdominal X-ray, which showed a possible small bowel obstruction, and the patient was immediately advised to visit the ED for further evaluation.InvestigationsPhysical examination revealed mild pain on palpation of the entire abdomen. Computed tomography (CT) of the abdomen and pelvis with intravenous (IV) and oral (PO) contrasts revealed a 2.7-cm gallstone in the terminal ileum with dilated loops of the small bowel in the right lower quadrant, indicative of gallstone ileus [fig1].
