Gallstoneileus: A Rare Cause of Smallbowel Obstruction

Biliary ileus is a rare complication of gallstones secondary to a bilio-digestive fistula with passage of a macro calculus in the small intestine and which may be responsible for intestinal obstruction. Its misleading symptomatology often leads to diagnostic delay which worsens the prognosis. Computed tomography is the main imaging modality for diagnosis of gallstone ileus. We report the case of a 63-year-old patient presenting vomiting with diffuse abdominal pain and inability to pass gas or stool evolving for 3 days. Abdominal computed tomography revealed moderate aerobilia, an atrophic gallbladder with air bubbles associated with small bowel obstruction due to a jejunal calculus. Laparotomy revealed the presence of a cholecystoduodenal fistula, a sclero-atrophic gallbladder with the presence of a stone obstructing the lumen in the jejunum; an enterolithotomy was performed with a cholecystectomy and closure of the fistula path in a single operative step; the postoperative outcome werefavorable.