Gallstone ileus presenting as intestinal obstruction in the elderly: Two case reports and literature review

Gallstone ileus is a rare and potentially life-threatening complication of chronic cholecystitis in the elderly. It results from the passage of a large gallstone through a bilio-digestive fistula into the gastrointestinal tract, causing mechanical obstruction. Early diagnosis and surgical intervention are crucial to reducing associated morbidity and mortality.

We report two cases of gallstone ileus. Case 1: A 76-year-old man presented with vomiting, abdominal pain, and bowel obstruction. CT scan revealed pneumobilia and an obstructing gallstone in the distal ileum. A 3 cm stone was extracted via enterotomy, and a loop ileostomy was performed due to poor bowel viability. Case 2: A 65-year-old hypertensive woman presented with acute intestinal obstruction and hypovolemic shock. CT imaging showed a gallstone in the distal ileum. Enterolithotomy was performed initially, and a second surgery three months later included cholecystectomy and fistula repair.

Gallstone ileus accounts for 1-4 % of intestinal obstructions, more common in the elderly. Rigler's triad is diagnostic but only seen in one-third of patients. CT imaging is the gold standard. Treatment typically involves enterolithotomy, with cholecystectomy and fistula repair deferred in high-risk patients.

Gallstone ileus should be suspected in elderly patients with signs of obstruction and pneumobilia. CT imaging is essential for diagnosis. Individualized surgical strategies optimize outcomes.