Gallstone ileus with spontaneous passage of the obstructing gallstone and resolution of small bowel obstruction: a case report

Gallstone ileus is a rare cause of mechanical small bowel obstruction that typically occurs in elderly patients with longstanding gallstone disease. It results from migration of a gallstone into the gastrointestinal tract through a biliary-enteric fistula, where it may become impacted within the bowel lumen. We present the case of an elderly female with insulin-dependent diabetes mellitus and heart failure who presented with abdominal pain, nausea and vomiting. Imaging established the diagnosis of gallstone ileus, and prior imaging demonstrated underlying cholelithiasis. Follow-up imaging several days later showed spontaneous passage of the obstructing gallstone with resolution of the bowel obstruction. This case highlights gallstone ileus as an important but uncommon cause of small bowel obstruction in elderly patients and demonstrates that spontaneous resolution may occur in selected cases.