A Seldom Encountered Intestinal Obstruction: Gallstone Ileus

Abstract

Gallstone ileus refers to mechanical small bowel obstruction secondary to luminal occlusion by a gallstone, most frequently in the distal ileum or ileocecal junction. The gallstone enters the enteral lumen through a cholecystoenteric fistula and should be large enough to be impacted in the small bowel. Although rare, it is a significant cause of mechanical small bowel obstruction in older adults. Computed tomography is the diagnostic modality of choice, and demonstrating Rigler’s triad is diagnostic of gallstone ileus. We here report the case of an 83-year-old male with gallstone ileus, wherein the impacted stone spontaneously passed, relieving the obstruction; subsequently, laparoscopic subtotal cholecystectomy and duodenal fistula repair were performed successfully. Additionally, we highlight using indocyanine green fluorescence imaging to navigate the complexities of biliary surgery. This case underscores the challenges in diagnosing and managing gallstone ileus and emphasizes the role of minimally invasive surgical techniques in complex biliary diseases.