When Stones Strike Twice: A Rare Case of Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Gallstone Ileus.

Gallstone ileus is a rare complication, typically resulting from a cholecystoenteric fistula. Its occurrence following endoscopic retrograde cholangiopancreatography (ERCP), particularly without evidence of fistula formation, is exceedingly uncommon. We present the case of a 69‑year‑old man with choledocholithiasis who developed gallstone ileus 48 hours after successful ERCP and stone extraction. The risk of gallstone ileus was anticipated during the procedure due to the large size of the bile duct stones. The patient subsequently developed symptoms of small bowel obstruction and underwent surgical intervention with enterolithotomy. Recognition of this potential complication, even in the absence of a fistula, is critical for timely diagnosis and management. This case emphasizes the need for careful procedural planning, documentation, and post‑procedural vigilance in patients with large biliary stones.