Gallstone Ileus as an Uncommon Etiology of Intestinal Obstruction: A Case Report.

Although gallstones are commonly confined to the biliary system, in rare instances, they may migrate into the intestinal tract and cause obstruction, a scenario most often observed in older adults with a history of gallbladder pathology. We describe the case of a 46-year-old woman who developed small bowel obstruction secondary to a large impacted gallstone, despite having no prior biliary disease. Her clinical presentation included a 15-day history of abdominal pain, bilious vomiting, and diarrhea. Laboratory tests revealed leukocytosis and acute kidney injury. Contrast-enhanced computed tomography demonstrated pneumobilia, small bowel obstruction, and a radiopaque ectopic gallstone. Exploratory laparotomy confirmed a 4 × 3 × 4 cm gallstone impacted 30 cm proximal to the ileocecal valve, which was successfully extracted via longitudinal enterotomy. The postoperative recovery was uneventful. This case illustrates the diagnostic and surgical challenges posed by gallstone ileus and emphasizes the importance of considering this condition even in patients without prior biliary pathology. Enterolithotomy proved to be a safe and effective treatment in this setting.