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Description

Gallstone ileus is a rare entity that occurs in only 0.3-0.5% of patients with cholecystitis and is the etiology of intestinal obstruction in less than 1% of cases. The infrequency with which it is encountered makes it a difficult diagnostic challenge, especially in the context of distracting radiologic findings.

76 year-old female initially presented with several days of diffuse abdominal pain, nausea, and vomiting. Initial ED workup at an OSH notable for  WBC 15.8, Tbili 0.6, AST/ALT 16/13. CT A/P demonstrated a large choledochoduodenal fistula with pneumobilia, along with multiple dilated loops of small bowel, and a 2.6cm ovoid intraluminal mass just proximal to transition point in the right pelvis. As a result, the patient was subsequently transferred to Butterworth Hospital given the concern for a pathologic choledochoduodenal fistula necessitating hepatopancreatobiliary surgery expertise. Following transfer, additional history revealed that the patient had a past surgical history of open cholecystectomy with CBD exploration and choledochoduodenostomy and retained CBD stone that was unable to be removed at time of initial intervention, consistent with a post-surgical etiology of patient's CT findings.

Patient was subsequently admitted for small bowel obstruction management. Diagnostic laparoscopy converted to exploratory laparotomy revealed a 3cm gallstone in the mid jejunum for which an enterotomy with gallstone extraction was performed. Postoperatively, the patient had a complete recovery and was ultimately discharged home.

Gallstone ileus is an uncommon cause of presentation to the emergency department, representing less than 1% of small bowel obstruction cases. Here we present a case of gallstone ileus in a patient with abnormal radiographic findings, highlighting the importance of maintaining an understanding of surgical procedures that are becoming historical in order to aid in proper assessment and management, especially in patients who present with rare conditions.

Publication Date

5-8-2026

Disciplines

Surgery

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2121

A Diagnostic Sleight of Hand: Gallstone Ileus in a Busy Abdomen

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