Gallstone Ileus: An Unusual Cause of Intestinal Obstruction

Abstract

Gallstone ileus is an uncommon complication of gallstones and a rare cause of intestinal obstruction. Typically as a result of the formation of cholecystoduodenal fistula, surgical removal of the gallstone is the mainstay of treatment in order to relieve the intestinal obstruction. A 34-year-old male with no history of cholelithiasis presented with features of a small bowel obstruction. CT scan of the abdomen demonstrated pneumobilia, a cholecystoduodenal fistula and small bowel obstruction, features suspicious for a gallstone ileus. The patient underwent a laparotomy and removal of two gallstones via an enterotomy. He was discharged home after an uneventful post-operative period. Gallstone ileus is an uncommon cause of mechanical bowel obstruction with often delayed presentation and non-specific symptoms. A high level of suspicion is required in at-risk groups, and in patients presenting with a bowel obstruction and known gallstone disease.

Keywords: cholecystoduodenal fistula; cholelithiasis; enterotomy; gallstone ileus; intestinal obstruction; laparotomy.

Figure 1. Dilation of intrahepatic ducts (white arrow), pneumobilia (white arrow), contracted gallbladder with thickened wall (blue arrow), dilated loops of small bowel (red arrow)

Figure 2. Cholecystoduodenal fistula formation (white arrow)

Figure 3. Impacted gallstone (black arrow)

Figure 4. Small bowel enterotomy for removal of the impacted gallstones (black arrow)