[Cholecystoenteric fistulae with giant gallstone ileus impaction.]

Gallstone ileus represents 0.06% of gallstone disease cases as a result of cholecystoenteric fistulae. The presentation is that of intestinal obstruction, the stone is most commonly impacted in the terminal ileum.

To present a case of a patient with intestinal obstruction due to a giant stone impacted in the proximal jejunum.

A 47 year old women presented with abdominal pain, distention, nausea and vomiting.An upper endoscopy revealed a deep duodenal ulcer penetrated to the pancreas. She had partial relief with medical treatment. She was admitted to ourhospital because a new episode of abdominal pain.Physical examination revealed an abdomen with diffuse pain, low peristalsis, leukocytes of 12 000/mm3, neutrophils of 85%, plain abdominal x-ray with intestinal obstruction and pneumobilia, CT scan with intestinal obstruction, hyperdense image in the intestinal lumen and a transition level.Surgery was performed, a giant stone of 6 cm in size was found in the proximal jejunum, an enter olithotomy was performed with primary closure.

Gallstone ileus is a rare condition ofa common disease. It is important in the differential diagnosis in elderly patients with intestinal obstruction. The aim of treatment is to relieve the intestinal obstruction by enterotomy and stone removal.