Gallstone Ileus Diagnosed During Endoscopic Evaluation: A Case Report

Gallstone ileus is a rare complication of calculous cholecystitis, resulting from the migration of a gallstone through a bilio-digestive fistula into the gastrointestinal tract, where it may cause mechanical obstruction. Diagnosis is often delayed due to a nonspecific clinical presentation. We report the case of a 73-year-old man with a history of unoperated vesicular lithiasis who presented with intense epigastric pain, intractable vomiting, and clinical and biological signs of dehydration. After intravenous rehydration, esophagogastroduodenoscopy revealed a fistulous orifice in the duodenal bulb with a gallstone emerging through it (an uncommon and directly informative diagnostic finding) suggestive of a cholecystoduodenal fistula. A non-contrast CT scan confirmed a jejunal obstruction. The patient underwent laparotomy with stone extraction, duodenal suture closure, and cholecystectomy, with a favorable outcome. This case highlights the value of upper gastrointestinal endoscopy as a complementary diagnostic tool in gallstone ileus, particularly when the stone remains accessible in the proximal gastrointestinal tract, and underscores the need for a high index of suspicion in elderly patients with atypical obstructive symptoms.