Gallstone Ileus in 83-Year-Old Woman

ABSTRACT

Gallstone ileus is a rare complication of the biliary stone, occurring in 0.3-0.5% of patients with cholelithiasis. The mortality rate is high at 12-27% and early diagnosis and prompt management can improve its prognosis. An 83-year-old woman was admitted to the hospital with abdominal pain. The patient previously had a hysterectomy and had received radiation therapy for uterine cancer. Plain abdominal x-ray showed typical findings of small bowel ileus with step ladder patterns. Computed tomography (CT) scan revealed biliary-enteric fistula with a 3-cm-sized gallstone in the jejunal loop. Surgical treatment was planned but due to the patient's wish, conservative treatment was provided for 10 days. In the follow-up CT scan, the stone had moved to the distal ileum but intestinal perforation was suspected. Ileocecectomy and adhesiolysis were performed and the patient recovered fully. Here we report a case of gallstone ileus that was treated by surgical removal after 10 days of conservative treatment.