A case of recurrent gallstone ileus within 1 week post enterolithotomy

Gallstone ileus (GSI) is a rare pathology, affecting 0.3-0.5% of people with cholelithiasis and accounting for 0.1% of mechanical bowel obstructions. It carries a high mortality of 12-27%. The rate of recurrence following a first episode of GSI is relatively high at 5-20%. Very early recurrence, within the first week, poses several challenges in both diagnosis and management. This case describes an 84-year-old woman who presented with a mechanical bowel obstruction secondary to gallstone impacted in the distal jejunum. This was managed operatively and the patient progressed well. The patient developed an early recurrent gallstone ileus, confirmed on computed tomography (CT) on Day 7 postoperatively. This was initially mistaken for a postoperative ileus. Early recurrent gallstone ileus can easily be mistaken for more common postoperative complications. Given its high mortality, consideration should be given to early investigation with CT to rule out recurrent GSI.