Gallstone Ileus Caused by Migration of Gallstone Through Cholecystoduodenal Fistula Resulting in Small Bowel Obstruction

Abstract

Gallstone ileus is a rare condition characterized by mechanical obstruction of the intestine due to gallstone impaction. Diagnosis is based on clinical history, symptoms, and characteristic Computed Tomography (CT) scan findings. Treatment typically involves surgical extraction of gallstones, with laparoscopy as an effective and potentially safer approach. Here, we describe a case of an 84-year-old woman with gallstone ileus presenting with small bowel obstruction.

Keywords: choledochoduodenal fistula; cholelithiasis; enterolithotomy; gallstone ileus; small-bowel obstruction.

Figure 1. CT of abdomen and pelvis without IV contrast on admission.

CT Abdomen Pelvis Non-Enhanced Imaging, A) Gallbladder intraluminal cholelithiasis (white arrow) and gas (yellow arrow). Extrahepatic bile duct pneumobilia (yellow dashed arrow). Inflammatory changes surrounding the gallbladder, involving the adjacent D1/D2 segments. B) Right lower quadrant small bowel transition point with rounded isodense mass (white dashed arrow) with proximal small bowel dilation. Note: both images demonstrate an abdominal aortic aneurysm with endovascular stenting.

Figure 2. Magnetic resonance imaging (MRI) of the abdomen without contrast.

Magnetic resonance imaging (MRI) of the abdomen without contrast, coronal single-shot fast spin echo (SS-FSE) sequence imaging. A) Cholecystoduodenal Fistula (yellow arrow) with several sub-centimeter calculi within the gall bladder (white dashed arrow). B-C) Multiple loops of small bowel dilation with a T2 hypointense rounded intraluminal mass (white arrow) at the small bowel transition point. Note: Both images demonstrate gastric and small bowel dilation.