A simple case of gallstone ileus?

A 68-year-old gentleman presented with abdominal distension and faeculent vomiting. He had a background of cerebral palsy with learning difficulties making history taking problematic. A CT scan suggested small bowel obstruction secondary to gallstone ileus. The most likely differential diagnosis was an inguinal hernia which was noted adjacent to the transition point. Laparotomy revealed grossly dilated small bowel with a 3-cm intraluminal gallstone. The gallstone was freely mobile within the lumen on the ileum and thus could not be causing obstruction. A caecal mass was also found, which was determined to be the cause of the obstruction. Limited ileocaecectomy was performed, which revealed a Duke's A adenocarcinoma. Gallstone ileus and caecal tumour can commonly be confused prior to surgery. There are however no previous reports of concurrent gallstone ileus and caecal tumour. Communication issues with the patient are likely to have contributed to the difficulty in diagnosis.