Gallstone ileus. A case treated with minilaparotomy and a review of the literature.

UNLABELLED: Gallstone ileus is a rare complication of cholelithiasis which occurs in less than 1% of patients and is the cause of 1- 4% of cases of small bowel obstruction. The pathogenesis involves the formation of a bilioenteric fistula. We report the case of gallstone ileus in an 81-year old woman with typical abdominal pain, arterial hypertension and coronary artery disease. An abdominal computed tomography (CT) scan showed pneumobilia, dilated loops of small bowel and an ectopic gallstone obstructing the intestinal lumen. The patient underwent enterolithotomy and a 5-cm stone 20 cm from the ileocecal valve was removed. In the literature enterolithotomy alone is the procedure most frequently used for gallstone ileus. Enterolithotomy plus cholecystectomy and/or fistulectomy is only indicated in selected patients. The clinical signs and symptoms depend on the site of the obstruction and usually include abdominal pain, nausea and vomiting. The diagnostic test of choice is an abdominal CT scan.

KEY WORDS: Cholecystoenteric fistula, Gallstone ileus, Minilaparotomy.