Gallstone ileus with sigmoid impaction through a cholecystocolic fistula: a case report
Bibliographic record
Abstract
Gallstone ileus is a rare cause of bowel obstruction. Colonic impaction, especially in the sigmoid colon, is extremely uncommon and often associated with diverticulosis or structural abnormalities. An 81-year-old woman presented with 2 weeks of abdominal pain, bloating, nausea, and vomiting. A computed tomography (CT) scan revealed a 6.2 cm gallstone in the sigmoid colon with pneumobilia and a cholecystocolonic fistula. After unsuccessful colonoscopic extraction, she underwent laparoscopic enterolithotomy with segmental sigmoid resection. She recovered without complications and remained symptom-free at her 6-week follow-up. Colonic gallstone ileus is rare and should be suspected in elderly women with obstruction and pneumobilia. A CT scan is the diagnostic gold standard. While endoscopy may work for small stones, surgery is usually required. Enterolithotomy with or without resection remains the safest approach in frail patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.004 | 0.003 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.004 | 0.005 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.011 | 0.006 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".