Recurrent gallstone ileus

We present the case of a recurrent gallstone ileus in a 76-year old female patient, which presented at our emergency department on January 15th 2015. In both episodes (January 16th and February 1st, 2015), only a simple enterotomy with stone extraction was performed. One year later, she is fully recovered and in good health. Recurrent gallstone ileus most often occurs in elderly patients with multiple co-morbidities. In our aging population, its prevalence is expected to increase. Because of the vague, intermittent symptoms, diagnosis of gallstone ileus is often delayed, contributing to its high mortality rate. CT-scan has become the preferred diagnostic imaging modality. Treatment should be individualized, with stone removal by enterotomy alone being the most commonly used strategy. For symptomatic patients, a two-stage procedure with urgent enterotomy followed by a delayed cholecystectomy can be considered. The one-stage procedure, in which enterotomy is combined with cholecystectomy and fistula closure, should be reserved for those few patients with minimal cholecystitis and in good overall condition.