Diagnosis and Management of Gallstone Ileus: An Individualized Approach Based on Clinical Presentation and Patient Comorbidities.

Gallstone ileus is an uncommon cause of mechanical intestinal obstruction. It results from the impaction of one or more gallstones within the gastrointestinal tract, usually after migrating through a cholecysto-duodenal fistula. The clinical presentation is nonspecific, including abdominal pain, vomiting, distension, and constipation. Computed tomography (CT) scan is the diagnostic modality of choice due to its high sensitivity. The treatment is surgical, with enterolithotomy being the initial procedure to extract the impacted stone. This case report describes a 74-year-old woman diagnosed with gallstone ileus, who was managed with a simple enterolithotomy without repair of the fistula or cholecystectomy, given her high surgical risk. Primary management of gallstone ileus should focus on resolving the intestinal obstruction via enterolithotomy. Although performing cholecystectomy and fistula repair reduces the risk of recurrence, the decision must weigh the benefits against the risks associated with more complex surgical interventions in frail patients.