Gallstone ileus 16 years postcholecystectomy?

Gallstone ileus, a rare complication of cholecystitis, occurs when the distal ileum becomes obstructed by gallstone causing, mechanical bowel obstruction. Gallstone ileus with history of cholecystectomy is exceptionally rare, with few cases documented in literature. This case report details the discovery of a large, impacted gallstone 16 years postcholecystectomy. An 87-year-old male presented with progressively worsening right-sided abdominal pain over 2-3 days. Exploratory laparotomy unveiled a 2.0 cm × 2.5 cm gallstone was obstructing the terminal ileum. Patient improved remarkably postoperatively and was discharged with resolution of symptoms. A potential cause for this large gallstone impaction within the terminal ileum is gallstone ileus, which can be explained with history of intentional or unintentional subtotal cholecystectomy or long cystic duct remnant. Both rare occurrences that allow gallstone formation or passage through a chronic cholecystoduodenal fistula due to inflammatory changes. With increasing trend toward subtotal cholecystectomies and division of cystic duct closer to the gallbladder neck, this case could potentially be explained as a gallstone ileus, despite extended postoperative intervals.