Gallstone Ileus with Cholecystoduodenal Fistula: A Rare Cause of Small Bowel Obstruction

Abstract

Gallstone ileus predominantly affects older adults, particularly women, and is regarded as a late complication of chronic gallstone disease. We report the case of a 60-year-old Malay woman with no known comorbidities who presented to the emergency department with a one-week history of worsening abdominal pain associated with colicky abdominal pain, bilious vomiting and obstipation. Clinical examination revealed abdominal distension with sluggish bowel sounds but no signs of peritonism. Laboratory investigations showed mild leukocytosis and evidence of dehydration, while liver function tests and serum amylase were within normal limits. Subsequent contrast-enhanced computed tomography of the abdomen confirmed the diagnosis by revealing dilated proximal small bowel loops with a transition point in the proximal jejunum, where a 2.9 cm intraluminal calcified mass consistent with a gallstone was identified. Associated findings of pneumobilia and a cholecystoduodenal fistula established the classical features of gallstone ileus. The postoperative course was uneventful, with early return of bowel function and discharge on postoperative day three. This case highlights the importance of maintaining a high index of suspicion for gallstone ileus even in patients without known biliary disease. It also supports the role of computed tomography in early diagnosis and demonstrates that enterolithotomy alone remains a safe and effective treatment option in selected patients, minimising operative risk while achieving favourable outcomes.