Gallstone ileus- A rare presentation in the era of rampant cholecystectomies

Gallstone ileus is a rare but potentially dangerous complication of cholelithiasis and represents about 1 % of the total cases of small bowel obstruction (Balthazar and Schechter, 1978). We report a case of 40 years old female who presented with signs and symptoms of bowel obstruction. On further investigation, a diagnosis of gallstone ileus was established. She was managed by laparoscopy-assisted enterolithotomy. Gallstone ileus, a form of mechanical intestinal obstruction, predominantly affects elderly females. Surgical management options includes enterolithotomy alone, two-staged enterolithotomy with delayed cholecystectomy and fistula repair, and single staged enterolithotomy and fistula repair. A laparoscopy-assisted enterolithotomy allows simultaneous direct diagnosis of gallstone ileus and assessment of pericholecystic adhesions along with cholecystoenteral fistula. Laparoscopy-assisted enterolithotomy was chosen for managing gallstone ileus in this patient, omitting cholecystectomy and fistula repair due to dense adhesions. The patient remained symptom free for 6 months post-surgery, suggesting potential spontaneous closure of the cholecystoduodenal fistula, affirming the viability of this less invasive approach.