Management of a Large Bowel Obstruction Secondary to a 5cm Gallstone in a Rural Setting: A Case Report

We present a case of a large bowel obstruction secondary to a large impacted gallstone measuring 5cm in the sigmoid colon. Significant features include a cholecysto-colonic fistula and the presence of a perforation initially missed on imaging. Endoscopic retrieval was attempted, followed by a Hartmann's procedure. This case highlights the significance of operative management in ensuring the safe treatment of colonic gallstone ileus, especially in a rural setting.