The Silent Presentation of Gallstone Ileus in a Surgery-Naïve Abdomen: A Case Report.

As an uncommon etiology of bowel obstruction that predominantly affects the elderly, gallstone ileus warrants attention because it frequently arises from cholecystoenteric fistulas and carries disproportionate morbidity when recognition is delayed. This case report details an unusual presentation in an elderly male patient with no history of abdominal surgery who exhibited nonspecific abdominal symptoms. Imaging studies identified Rigler's triad, and computed tomography (CT) confirmed the presence of an ectopic gallstone in the proximal ileum. The patient promptly underwent surgical intervention, including segmental bowel resection due to transmural ischemia, followed by primary anastomosis. His postoperative recovery was uneventful. This case emphasizes the importance of early recognition of gallstone ileus, highlights the diagnostic value of CT, and demonstrates that bowel resection may be necessary when bowel compromise is present. Increased awareness among clinicians can enhance outcomes and reduce complications in similar cases.