Multiple gallstones causing ileus twenty years after cholecystectomy.

Area of Science:

• Gastroenterology
• Surgical Pathology

Background:

• Gallstone ileus is a rare complication of gallstones, causing small bowel obstruction in <0.5% of obstruction cases.
• It typically results from a large gallstone eroding into the bowel via a biliary-enteric fistula.

Observation:

• A patient presented with small bowel obstruction 20 years after cholecystectomy.
• The obstruction was caused by seven gallstones impacted in the jejunum at a prior anastomosis site.

Findings:

• This case is unusual due to the number of stones (seven) and their location (jejunum at anastomosis).
• The stones collectively caused a significant mechanical obstruction.

Implications:

• Highlights the potential for multiple gallstones to cause obstruction long after cholecystectomy.
• Suggests considering gallstone ileus in patients with prior abdominal surgery presenting with obstruction, even with multiple stones.