Gallstone ileus: a comprehensive approach in the context of human medicine - case report and clinical considerations

Abstract

Gallstone ileus, a rare complication of cholelithiasis, predominantly affects elderly women with other relevant medical conditions. This condition arises due to the impaction of gallstones in the ileum after passing through a bilioenteric fistula. The clinical picture often manifests itself with nonspecific symptoms and insidious obstruction, sometimes resulting in a delay in diagnosis. Computed tomography (CT) is crucial for research, being considered the gold standard tool. The morbidity and mortality associated with the gallstone ileus are directly related to the advanced age of the patients and the presence of concomitant comorbidities, negatively influencing the prognosis. This study describes the case of a 65-year-old woman, diabetic and hypertensive, presenting with an acute obstructive abdomen. The obstruction in the terminal ileum was evidenced by CT, not allowing the determination of the obstructive factor. The diagnosis of gallstone ileus was confirmed during the exploratory laparotomy, which identified a large impacted calculus in the distal ileum, with expansion of loops upstream. The surgical approach included enterotomy for calculus extraction, followed by two-plane enterorrhaphy and washing of the abdominal cavity. Due to the patient's clinical conditions, cholecystectomy and correction of the cholecystoduodenal fistula were not performed in the same surgery.