Gallstone ileus 30 years status postcholecystectomy.

Area of Science:

• Gastroenterology
• Surgical Case Reports

Background:

• Gallstone ileus is an uncommon complication of chronic cholecystitis, characterized by a fistula between the gallbladder and the gastrointestinal tract, leading to small bowel obstruction.
• It is associated with significant morbidity and mortality, often exacerbated by patient comorbidities and delayed diagnosis.

Observation:

• A 94-year-old female presented with symptoms of small bowel obstruction, including nausea, vomiting, and abdominal tenderness.
• Imaging revealed a 2.5-cm obstruction in the small bowel. Notably, the patient had a history of cholecystectomy 30 years prior.

Findings:

• Surgical exploration identified and removed a 2.5-cm gallstone impacted in the ileum, causing the obstruction.
• This finding was unexpected given the patient's prior cholecystectomy.

Implications:

• This case underscores the importance of including gallstone ileus in the differential diagnosis for small bowel obstruction, irrespective of a prior cholecystectomy.
• Even in patients with a history of gallbladder removal, the possibility of a retained or migrated gallstone causing obstruction should be considered, especially in elderly patients with comorbidities.