What question did this study set out to answer?

To describe a case of gallstone ileus revealing Mirizzi syndrome due to a cholecysto-duodenal fistula.

June 5, 20260 citationsOpen Access

Small‑Bowel Obstruction Revealing Mirizzi Syndrome: Gallstone Ileus from a Cholecysto‑Duodenal Fistula with a 7‑Cm Ileal Enterolith in a 76‑Year‑Old Insulin‑Dependent Diabetic

PAPr ELWASSI Anas DMDr RAYADI Mahassin DMDr KHADIRI Mohammed

Key Points

To describe a case of gallstone ileus revealing Mirizzi syndrome due to a cholecysto-duodenal fistula.
Urgent laparotomy performed on a 76-year-old patient with a complex abdominal presentation.
Exploration revealed a 7-cm enterolith impacted in the ileum and associated biliary fistula.
Procedures included enterolith extraction, disconnection of the fistula, and mechanical duodenal exclusion.
Successful extraction of the enterolith and repair of the involved structures.
No bowel resection was required, limiting operative risks associated with the patient's comorbidities.
Combined surgical strategy effectively relieved obstruction and addressed biliary issues.

Abstract

Background: Gallstone ileus is a rare cause of small‑bowel obstruction in elderly patients and may result from migration of large gallstones through a bilioenteric fistula. Mirizzi syndrome complicated by cholecysto‑enteric fistula (Mirizzi type V) may underlie such presentations and complicate operative planning.Case presentation: A 76‑year‑old man with 15 years of insulin‑dependent type 2 diabetes presented after 6 days of progressive abdominal distension, obstipation and colicky pain without vomiting or fever. On examination he was hemodynamically stable; the abdomen was distended and tympanitic. Plain abdominal radiography demonstrated multiple small‑bowel air‑fluid levels. Contrast CT (24/03/2026) showed dilated small bowel with a distal ileal transition at two spontaneously hyperdense endoluminal oval bodies and intrahepatic branching gas (aeroportia); the gallbladder was not visualized. Laboratory tests showed leukocytosis and elevated CRP; creatinine was elevated on admission.The patient underwent urgent laparotomy. Exploration revealed marked small‑bowel dilation with a 7‑cm macro‑calculus impacted in an ileal loop 4 m from the ligament of Treitz and 60 cm from the ileocecal valve; no macroscopic intestinal ischemia was seen. A cholecysto‑duodenal fistula (Mirizzi Vb) with a scleroatrophic gallbladder occluded by greater omentum was identified. Procedures performed: enterolith extraction via enterotomy with Heineke–Mikulicz enteroplasty; disconnection of the cholecysto‑duodenal fistula; Kehr (T)‑tube (Ch12) drainage of the common bile duct; directed Pezzer drainage of the duodenal fistula; mechanical duodenal exclusion and omega Roux (Jordan) gastrojejunostomy; placement of pre‑ and retro‑pedicular drains. No bowel resection was required.Conclusion: This case illustrates gallstone ileus that revealed Mirizzi syndrome with cholecysto‑duodenal fistula. In elderly, comorbid patients a pragmatic combined strategy—rapid obstruction relief, controlled biliary drainage and protection of duodenal repair—can treat both obstructive and biliary pathology while limiting operative risk.

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