Twin-Stone syndrome: A rare presentation of gallstone ileus

Introduction: Gallstone ileus is a rare cause of mechanical bowel obstruction resulting from gallstone migration through a cholecystoenteric fistula, most commonly impacting the ileocecal valve. Bouveret syndrome, a rare variant, involves gastric outlet obstruction from proximal impaction. Case Report: We present the case of a 61-year-old female with a closed-loop obstruction caused by multiple impacted gallstones. Surgical management for this patient included enterotomy, cholecystectomy, pyloroplasty, common bile duct resection with hepaticojejunostomy, and closure of the cholecystoduodenal fistula. The patient recovered well with a short episode of post-operative atrial fibrillation. Conclusion: This case of Twin-Stone syndrome highlights the complexity of treating gallstone ileus, particularly with more complicated sites of obstruction combined with fistula formation. Surgical management of this complex disease should be tailored to the patient’s clinical scenario to provide optimal outcomes in this high-risk population.