Gallstone ileus: spectrum of presentation and surgical management-a three-case series with an emphasis on minimally invasive management.

Gallstone ileus is a rare cause of mechanical bowel obstruction, predominantly affecting elderly patients with multiple comorbidities. We present a series of three patients illustrating the variability in clinical presentation, imaging findings, and surgical management. An 86-year-old male underwent successful laparoscopic enterolithotomy with an uneventful postoperative course and discharge on postoperative day 4. In contrast, two female patients (aged 77 and 84 years) required open surgery due to more severe clinical presentation and developed significant postoperative complications, including prolonged intensive care unit stay and delayed recovery. One case involved an atypical localization of the gallstone in the duodenum, representing a variant within the spectrum of Bouveret syndrome. These cases highlight the importance of early diagnosis and individualized surgical management. Minimally invasive approaches may offer improved postoperative outcomes in selected patients; however, careful patient selection remains crucial.