Gallstone Ileus Occurring 35 Years After Cholecystectomy in an Elderly Male

Gallstone ileus occurring decades after cholecystectomy is exceptionally rare and represents an uncommon cause of small bowel obstruction (SBO) in elderly patients with prior gallstone disease. A 72-year-old male with a remote history of cholecystectomy presented with nausea, vomiting, and diffuse abdominal pain. CT imaging demonstrated an SBO with a calcified intraluminal mass in the distal ileum. After initial conservative management, the patient underwent exploratory laparotomy with extensive adhesiolysis, enterolithotomy, and primary ventral hernia repair. A large, calcified gallstone was removed from the distal ileum, confirming gallstone ileus. Postoperatively, the patient developed a transient superficial wound infection managed with bedside debridement and antibiotics, with full recovery and discharge on postoperative day ten. Gallstone ileus many years following cholecystectomy likely results from a persistent, chronically developed biliary-enteric fistula enabling delayed stone passage. Its nonspecific presentation and rarity can delay diagnosis, highlighting the importance of maintaining a high index of suspicion in elderly patients presenting with SBO and intraluminal calcified densities. This case emphasizes that gallstone ileus can occur long after cholecystectomy. Early recognition and timely operative intervention remain essential for optimal outcomes.