Small bowel obstruction secondary to gallstone ileus: An unusual presentation of cholelithiasis

Gallstone ileus remain a rare but significant cause of small bowel obstruction, especially in the elderly population. It is associated with high mortality due to nonspecific symptoms and delayed diagnosis. A 69-year-old male with a history of cholelithiasis presented with symptoms and signs suggestive of small bowel obstruction. Computed tomography (CT) scan showed pneumobilia, and small bowel obstruction, suggestive of gallstone ileus. Initial management involved exploratory laparotomy with enterotomy and gallstone removal followed by cholecystectomy and fistula closure three months later. Gallstone ileus results from large gallstones causing mechanical intestinal obstruction, often via a cholecysto-intestinal fistula. CT scans are crucial for diagnosis, with surgical options for better patients' outcomes. Management of gallstone ileus involves removing the obstruction and repairing the cholecysto-intestinal fistula, but surgical approaches vary based on patient factors. Surgeons should be aware of the variable clinical presentations and the rationale behind choosing either a one-stage or staged surgical approach, particularly in managing patients with fistulas or severe adhesions. •Gallstone ileus is a rare cause of mechanical small bowel obstruction.•CT imaging plays a crucial role in diagnosis and treatment.•Successful management involves a two-stage surgical approach.•Early recognition and surgical intervention led to a favorable outcome.