Authors:

Abstract

Gallstone ileus (GI) is a mechanical type of intestinal obstruction (MIO) due to the impaction of one or multiple stones within the intestinal lumen. GI is one of the rare causes of MIO that accounts for less than 1% of the cases which is common in the elderly population with multiple comorbidities. The presentation non-specific, and this often leads to a delay in diagnosis. Mainly the diagnosis of GI relies on a radiological approach upon background clinical history. The commonly practised surgical management is, relieving obstruction by stone retrieval via an enterotomy.

The case describes a 78 year old patient presented with gallstone ileus, managed successfully without entrotomy by evacuating the stone cholecysto-enteric fistula (CEF). Intra-operative assessment of stone size, CEF opening size, and the status of the intestine proximal to the obstruction will give a chance to retrieve the stone via CEF without enterotomy in the management of GI in addition to the commonly used surgical techniques.

Keywords: Cholecysto-enteric fistula, Pneumobilia, Gallstone ileus, Rigler’s triad, Enterotomy, Cholecystectomy