Ectopic Gallstone Presenting As Small Bowel Obstruction: A Diagnostic Challenge.

Gallstone ileus represents an infrequent etiology of mechanical bowel obstruction and may be difficult to identify because of its nonspecific clinical manifestations. We describe the case of an 80-year-old woman who presented with abdominal pain, nausea, vomiting, and constipation. Computed tomography demonstrated pneumobilia, a cholecystoduodenal fistula, and an ectopic gallstone lodged at the ileocecal valve. Surgical exploration confirmed the diagnosis, and the patient underwent enterotomy with stone extraction, partial cholecystectomy, and fistula repair. Recovery after surgery was favorable and without major complications. This report highlights the importance of considering gallstone ileus in older adults with bowel obstruction and emphasizes the usefulness of computed tomography for timely diagnosis and surgical planning. Management should be individualized according to intraoperative findings and the patient's overall clinical status.