Elgazar Amr, Hindawi Mahmoud Diaa, Abdelaty Ezzeldin Ahmed, Salem Mohamed Ayman, Kalmoush Abd-Elfattah, Awad Ahmed K
Department of General Surgery, Ain Shams University Hospitals, Cairo, Egypt; Royal Free Hospital, Royal Free London Foundation Trust, Great London, United Kingdom of Great Britain and Northern Ireland.
Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Int J Surg Case Rep. 2025 Sep;134:111684. doi: 10.1016/j.ijscr.2025.111684. Epub 2025 Jul 18.
Gallstone ileus (GI) is a rare and serious complication of cholelithiasis, causing intestinal obstruction due to the migration of gallstones into the bowel lumen. It predominantly affects elderly patients and often lacks specific symptoms, delaying diagnosis and increasing mortality.
We report a case of a 60-year-old male with signs of small bowel obstruction and a known history of gallstones. CT imaging confirmed a large gallstone impacted in the distal ileum. The patient underwent exploratory laparotomy with distal enterotomy and stone extraction, followed by an uneventful recovery.
This case illustrates the decision-making process in choosing between enterolithotomy, one-stage, and two-stage surgical approaches. A distal enterotomy was selected based on intraoperative anatomy, as the distal bowel was decompressed and healthier. Simultaneous cholecystectomy and fistula repair were deferred due to the patient's frailty, consistent with a two-stage strategy. A comprehensive literature review is provided to guide operative decision-making in similar cases.
Anatomical and clinical context should guide surgical strategy in gallstone ileus. Distal enterotomy with enterolithotomy can be safe and effective in selected cases, with delayed biliary surgery reserved for symptomatic recurrence. Further research is needed to clarify the optimal timing and approach.
胆石性肠梗阻（GI）是胆石症一种罕见且严重的并发症，因胆结石移入肠腔导致肠梗阻。它主要影响老年患者，且常缺乏特异性症状，从而延误诊断并增加死亡率。
我们报告一例60岁男性患者，有小肠梗阻体征且有胆结石病史。CT成像证实一枚大的胆结石嵌顿于回肠末端。患者接受了剖腹探查术，行回肠远端切开取石，随后恢复顺利。
该病例说明了在肠切开取石术、一期手术和二期手术方法之间进行选择时的决策过程。根据术中解剖结构选择了回肠远端切开术，因为远端肠管已减压且状况较好。由于患者身体虚弱，同期胆囊切除术和瘘管修复术被推迟，这与二期手术策略一致。提供了全面的文献综述以指导类似病例的手术决策。
解剖学和临床情况应指导胆石性肠梗阻的手术策略。在某些病例中，回肠远端切开取石术可能是安全有效的，对于有症状复发的情况可延迟进行胆道手术。需要进一步研究以明确最佳时机和方法。
