Gallstone ileus. A case report

Background: Gallstone ileus is defined as a mechanical intestinal obstruction that occurs as a complication following the passage of a gallstone into the intestinal tract through a fistula. This fistula develops after a chronic inflammatory process of the gallbladder, creating a communication—most commonly, a cholecystoduodenal fistula. Its diagnosis requires a high index of suspicion, as it is a rare cause of intestinal obstruction. The typical clinical presentation is in older women with a history of biliary disease, characterized by sudden onset of abdominal distension and pain, vomiting, and constipation. Imaging studies, such as CT scans, can reveal signs like pneumobilia or ectopic gallstones. Management is always surgical to resolve the acute obstruction, typically through enterolithotomy. This procedure can be combined with or without specialized fistula management, depending on the patient's condition and the surgeon's judgment. We present the case of a 64 year old male who presented with a typical intestinal obstruction and a history of cholelithiasis. Imaging identified the three criteria of Rigler's triad, which are only present in about 10% of gallstone ileus cases. This case was treated at our institution. Keywords: Gallstone ileus, intestinal obstruction, cholelithiasis.