Introduction: A gallstone in the gallbladder may cause acute inflammation and eventually move into the adjacent duodenum through a cholecysto-enteric fistula. Regardless of the size of the stone, it can cause small bowel obstruction which is called gallstone ileus. It is a rare condition that accounts for one to four percent of intestinal obstructions.
Materials and methods: A 63-year-old female patient was admitted with a one-month history of left sided abdominal pain associated with vomiting and abdominal distention. X-ray and abdominal ultrasound were performed and the following changes were discovered: dilated small bowel loops up to 42mm in the lower left abdominal quadrant with inflammatory changes and ascites. The patient underwent an emergency operation. Midline laparotomy was performed. Abundant quantity of intestinal content was found engaging all three floors of the abdominal cavity. A biliary calculus was found in the jejunum 50 cm from the ligament of Treitz. The stone was five cm in diameter, causing a total obstruction of the small intestine. There was a perforation of the bowel proximally from the concrement.
Results: 20 cm of the jejunum were resected during the surgery. The passage was restored via latero-lateral anastomosis. After a normal postoperative period without complications the patient was discharged on the 13th postoperative day in good general condition.
Conclusion: Gallstone ileus is a condition with high rates of mortality. In elderly patients presenting with symptoms of small bowel obstruction, gallstone ileus should be included in the differential diagnosis. Surgical treatment is necessary once the diagnosis has been made.
