Gallstone Ileus Secondary to Cholecystoduodenal Fistula: A Case Report and Review of Surgical Management.

Gallstone ileus is a rare cause of small bowel obstruction (SBO). It occurs when a gallstone passes through a cholecystoenteric fistula and obstructs the bowel. This case report aims to share our experience in managing an uncommon cause of SBO and to discuss available surgical management options, including the rationale for a staged approach in patients with significant comorbidities. We describe a 63-year-old woman with a history of hypertension, diabetes, gallstones, and uterine cancer treated with hysterectomy and radiation therapy, who presented with right upper quadrant pain and vomiting and subsequently developed signs of SBO. A computerized tomography scan of the abdomen and pelvis revealed a cholecystoduodenal fistula with evidence of a stone in the distal ileum. She subsequently underwent emergency enterolithotomy, successfully removing the stone, and was scheduled for a cholecystectomy at a later date to reduce her surgical risk. We discuss the three approaches to the surgical management of gallstone ileus-enterolithotomy alone, one-stage surgery (enterolithotomy + cholecystectomy with fistula repair), and two-stage surgery (enterolithotomy and delayed cholecystectomy with fistula repair).