Gallstone Ileus With Atypical Gastrointestinal Bleeding: A Case Report and Literature Review.

Gallstone ileus is a rare complication of cholelithiasis. Its diagnosis is challenging due to a nonspecific presentation and high morbidity and mortality related to age and comorbidities. An 87-year-old female with a history of hypertension presented with obstructive abdominal pain, hyporexia, and "coffee-ground" emesis. Upon admission, she showed hemodynamic instability [blood pressure (BP) 83/51 mmHg] and acute renal failure [Creatinine (Cr) 1.34 mg/dL]. Computed tomography revealed Rigler's triad, consisting of small bowel obstruction, neumobilia, and an ectopic gallstone. Exploratory laparotomy identified a stone impacted 140 cm from the Treitz ligament. A "milking" maneuver and simple enterolithotomy were performed, extracting a 2.5 cm gallstone. The patient had a favorable recovery and was discharged on the sixth postoperative day. Gallstone ileus should be suspected in geriatric patients with obstructive symptoms, even when presenting with atypical gastrointestinal bleeding. In extremely frail or hemodynamically unstable patients, simple enterolithotomy remains the gold standard to reduce surgical time and intraoperative complications.