Work

Gallstone Ileus After Conservative Management of Acute Cholecystitis and Refusal of Interval Cholecystectomy: A Case Report

Year: 2026

Type: article

Abstract: Background and Clinical Significance: Gallstone ileus (GI) is a rare but serious complication of gallstone disease. This condition is characterized by migration of gallstones through a cholecystoenteric fistula, resulting in mechanical bowel obstruction. GI primarily affects older patients with multiple comorbidities. Case Presentation: Herein, we describe a case of 68-year-old Saudi woman with a history of end-stage renal disease, pulmonary hypertension, diabetes mellitus, bronchial asthma, and atrial fibrillation. She presented with acute calculous cholecystitis. Due to her condition, she was managed conservatively initially. The patient was recommended laparoscopic cholecystectomy but she declined due to fear of anesthesia-related complications. She re-presented after two months with abdominal pain, vomiting, distension, and constipation. Computed tomography (CT) scan showed a 3.2 cm ectopic gallstone impacted in the distal ileum with proximal bowel dilatation and segmental ischemia, confirming GI. Laparotomy showed bowel ischemia and localized perforation. The patient was managed with enterolithotomy, resection of 25 cm of distal ileum, and primary anastomosis. Post-surgery, the patient had favorable recovery. Conclusions: This case highlights need for early diagnosis and appropriate management of GI in patients with multiple comorbidities.

Source: Reports — Medical Cases Images and Videos

DOI: 10.3390/reports9030234

Authors: Hussain Alessa, Afnan Alshayeb, Renad Aljasser, Abdulaziz Ali Qahtani

Institutions: National Guard Health Affairs, Dar Al Uloom University

Language: English

Topic: Biliary and Gastrointestinal Fistulas

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,689