Two-Stage Laparoscopic Management of Gallstone Ileus Secondary to Cholecystoduodenal Fistula in an Elderly Female: A Rare Case Report

Gallstone ileus is an uncommon but potentially life-threatening consequence of chronic cholelithiasis, typically affecting elderly women. It arises when a large gallstone erodes through the gallbladder wall into an adjacent part of the gastrointestinal tract, forming a cholecystoenteric fistula, most commonly a cholecystoduodenal fistula. The stone then migrates into the bowel and can cause obstruction, most frequently at the ileocecal valve because of its small lumen. The clinical presentation often mimics other causes of intestinal obstruction, making diagnosis challenging and frequently delayed. Radiologic imaging, especially computed tomography (CT), plays a vital role in identifying features such as pneumobilia, ectopic gallstone, and bowel distension—collectively known as Rigler’s triad. Surgical intervention remains the cornerstone of treatment, with debate persisting between one-stage versus two-stage procedures. In this report, we describe the effective management of gallstone ileus in an 82-year-old female patient using a two-stage laparoscopic procedure. This case highlights the diagnostic challenges, surgical decision-making, and the potential role of minimally invasive techniques in high-risk patients.