A Case of Recurrent Gallstone Ileus Treated with Enterolithotomy Alone

Abstract

Introduction: Gallstone ileus is rare but with high mortality. Although gallstone ileus usually requires urgent enterolithotomy, cholecystectomy, and fistula closure, we present a case of recurrent gallstone ileus treated with enterolithotomy alone.

Case presentation: A 69-year-old female presented to the emergency department with nausea, emesis, and abdominal pain. After computed tomography revealed the diagnosis of gallstone ileus, enterolithotomy was performed without postoperative complications. Cholecystectomy and fistula closure were not performed due to inaccessibility to the gallbladder and the high surgical invasion required. Four months later, the patient developed gallstone ileus again. A second enterolithotomy was performed immediately, resulting in a favorable outcome without complications.

Conclusion: In managing gallstone ileus, particularly in cases with surgical limitations, a less invasive strategy could be a reasonable option.

Keywords: Enterolithotomy; Gallstone ileus; Recurrent gallstone ileus.

Fig. 1.

Abdominal computed tomography at the first visit. The gallbladder wall was thick and one gallstone was inside (dashed arrow). The gallstone was impacting the small intestine (arrow).

Fig. 2.

Removed impacting gallstone at the first surgery (a) and second surgery (b).

Fig. 3.

Abdominal computed tomography at revisit. The gallstone located in the gallbladder in previous computed tomography imaging (Fig. 1) was impacting the small intestine (arrow).