Fruit pit mimicking gallstone ileus: A diagnostic pitfall on CT-Case report

Small bowel obstruction due to ingested fruit pits is rare and often underrecognized. In exceptional cases, these foreign bodies may mimic the clinical and imaging features of gallstone ileus, a complication of cholelithiasis involving biliary-enteric fistula formation and gallstone migration into the intestinal lumen. Such presentations may lead to misdiagnosis and inappropriate management. This case highlights an uncommon but clinically relevant diagnostic pitfall: a pseudo-gallstone ileus caused by an impacted apricot pit in a patient with a prior ileocolic anastomosis. An Italian Caucasian 49-year-old woman presented with acute abdominal pain and vomiting. Her medical history included a remote ileocolic resection for intestinal ischemia. Physical examination revealed a diffusely tender abdomen without signs of peritonitis. Biochemical investigations showed mild hepatopancreatic enzyme elevation and a low-grade inflammatory response. Plain abdominal radiography demonstrated radiopaque intraluminal structures in the right iliac fossa and features of small bowel obstruction. Contrast-enhanced computed tomography confirmed mechanical obstruction above a prior ileocolic anastomosis, with three hyperdense intraluminal masses in the distal ileum and calcified gallstones in the gallbladder. Although no aerobilia or biliary-enteric fistula was detected, imaging raised suspicion of gallstone ileus. Colonoscopy revealed a stenotic ileocolic anastomosis and three hard, stone-like masses in the terminal ileum. Two were endoscopically mobilized into the colon; the third resisted lithotripsy. Magnetic resonance cholangiopancreatography showed no evidence of biliary-enteric fistula. On repeat endoscopy, after balloon dilation of the anastomosis, the remaining object was retrieved and identified as an apricot pit. Upon questioning, the patient recalled recent ingestion of stone fruits. The final diagnosis was mechanical small bowel obstruction from an impacted fruit pit mimicking gallstone ileus. The patient recovered fully and was discharged with dietary recommendations. This case underscores the importance of considering alternative diagnoses when imaging suggests gallstone ileus, especially in the absence of a biliary-enteric fistula. Radiologists and clinicians should be aware that ingested fruit pits may resemble calcified biliary calculi on cross-sectional imaging. A high index of suspicion and multidisciplinary collaboration are essential to avoid misdiagnosis and unnecessary surgical intervention.