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Gallstone ileus with concomitant cholecystoduodenal and cholecystocolonic fistulae: surgical management with enterolithotomy, fenestrating partial cholecystectomy, and primary fistula repair – a case report

Year: 2026

Type: article

Abstract: Introduction and importance: Gallstone ileus with concomitant cholecystoduodenal and cholecystocolonic fistulae is rare. This report describes the successful one-stage surgical management of a high-risk patient without preoperative computed tomography (CT) imaging. Case presentation: ) with atrial fibrillation presented with symptoms of bowel obstruction for more than 2 weeks. Despite complete mechanical small-bowel obstruction, she had no perforation or ischemia. The diagnosis was confirmed by plain radiographs and an oral contrast study; CT was deferred because of acute kidney injury. Clinical discussion: At laparotomy, a large obstructing gallstone was found in the distal ileum together with a second large stone in the gallbladder at the fistula site. A single-stage procedure (enterolithotomy, fenestrating partial cholecystectomy, and primary repair of both fistulae) was performed. The patient recovered well and was discharged on postoperative day 12. Conclusion: This case illustrates that definitive one-stage surgery can yield good short-term outcomes in carefully selected high-risk patients with dual fistulae and a residual stone when clinical and basic imaging findings are concordant, even without cross-sectional imaging.

Source: International Journal of Surgery Case Reports

DOI: 10.1097/rc9.0000000000001084

Authors: Mozamil Mohamed, Khomotsho Lekala, Bisola M. Adewuyi, Etshumang Daniel Molefe

Institution: University of the Witwatersrand

Language: English

Topic: Biliary and Gastrointestinal Fistulas

Subfield: Gastroenterology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090