From diagnosis to treatment: a pictorial guide of gallstone ileus

Abstract Gallstone ileus is a rare cause of bowel obstruction, accounting for only 0.3–0.5% of patients with cholecystolithiasis, and it predominantly affects elderly women. This condition develops when gallstones migrate through a bilio-enteric fistula, typically resulting from repeated episodes of acute cholecystitis. Gallstones are the cause of bowel mechanical obstruction and the ileocecal valve represents the most common site of obstruction because it is the narrowest part of the bowel. For the same reasons, the incidence of gallstone ileus increases in patients that suffer bowel strictures, including those with Crohn’s disease or diverticulitis. Symptoms are non-specific and resemble those of other types of bowel obstruction, including abdominal pain, vomiting, and constipation. These symptoms may make initial diagnosis challenging. In fact, radiological imaging plays a crucial role in diagnosing this condition and contrast-enhanced computed tomography (CT) is the diagnostic method of choice. The Rigler triad is pathognomonic but not always present and it is represented by pneumobilia, sign of mechanical bowel obstruction and ectopic gallstones. Treatment options include enterolithotomy, a surgical procedure to remove obstructing gallstone, sometimes in conjunction with cholecystectomy and closure of the bilio-enteric fistula. Bowel resection may be needed in cases of complications. Early diagnosis and timely surgical intervention are critical to improving patient outcomes and preventing further complications.