Gallstone ileus and a three centimeters stone in terminal ileum: a case report

Gallstone ileus is a rare complication of cholelithiasis found in less than 0.5% of patients. It is an uncommon cause of small bowel obstruction, accounting for 1% to 3% of all mechanical bowel obstructions and over 25% of nonstrangulated bowel obstructions in patients older than 65 years with a female predominance. We report a 60-year-old woman who was referred to our hospital because of abdominal pain, nausea, vomiting and constipation forty days prior to admission. An upright abdominal X-ray showed air fluid levels and an oval calcified opacity in the region of right iliac fossa. The ultrasonographic examination revealed air in billiary tree and several small stones in the gallbladder. Follow up of abdominopelvic CT scan showed severe distention of small intestinal loops, pneumobilia and a 3cm-calcified intraluminal mass. The clinical diagnosis of gallstone illeus was made, but unfortunately her general condition worsened with the decline in Glasgow Coma Scale declined since she was suffered an extensive cerebrovascular accident and eventually she died of cardiac arrest. Inspired by the mentioned case we reviewed the literature on the cause, diagnosis and treatment of gallstone ileus.