Double Large Gallstones Ileus: An Unusual Cause of Mechanical Large Bowel Obstruction

Gallstone ileus (GSI) is an unusual complication of cholelithiasis resulting from the formation of a fistula between the gallbladder and the gastrointestinal tract. When a sufficiently large gallstone passes into the bowel, it can obstruct a narrowed segment. The most common site of GSI is the terminal ileum, typically presenting as small bowel obstruction. However, a rare but potentially serious complication of calculous cholecystitis is gallstone sigmoid ileus, which can cause large bowel obstruction. This report presents the case of a 59-year-old woman who exhibited symptoms of large bowel obstruction caused by a large gallstone lodged in the sigmoid colon, along with a simultaneous large gallstone in the cecum, as revealed by multiplanar abdominopelvic CT. Both gallstones had migrated from the gallbladder to the large bowel through a cholecystoduodenal fistula. Initial conservative and endoscopic management attempts were unsuccessful, leading to the need for emergency surgery. Ultimately, the patient made a full recovery.