Srikant Agrawal, Pratiksha Paudel, Bidur Khatiwada, Kishor Manandhar
National Academy of Medical Sciences, NAMS, Bir Hospital, Department of General Surgery, Kathmandu, Nepal.
Bharatpur Hospital, Kathmandu, Nepal.
Int J Surg Case Rep. 2025 Oct;135:111894. doi: 10.1016/j.ijscr.2025.111894. Epub 2025 Sep 4.
Gallstone ileus is a rare cause of mechanical small bowel obstruction, accounting for 1-4 % of cases and is most common in elderly females. It arises from the passage of a large gallstone through a cholecysto-enteric fistula into the intestinal lumen, where it lodges-typically in the terminal ileum-causing obstruction.
A 52-year-old male presented with four days of abdominal pain, vomiting, distension, and constipation. He had a 22-year history of gallstones but no prior biliary symptoms. Imaging revealed small bowel obstruction with a cholecysto-duodenal fistula and a 3.5 cm gallstone impacted in the ileum. He underwent successful open enterolithotomy with an uneventful recovery.
Gallstone ileus commonly affects elderly females due to higher prevalence of gallstones and chronic cholecystitis. Risk factors for gallstones include obesity, diabetes, and smoking, none of which were present in this patient. Delayed presentation may be attributed to low awareness, limited access to care, and absence of prior symptoms. CT abdomen is the gold standard for diagnosing gallstone ileus, surpassing X-ray and ultrasound, revealing Rigler's triad-pneumobilia, ectopic stone, and obstruction. Surgical options include enterolithotomy alone or combined with cholecystectomy and fistula repair. In stable patients, enterolithotomy alone is preferred due to lower morbidity.
Gallstone ileus should be suspected in bowel obstruction even in atypical populations. Prompt diagnosis and minimally invasive surgical management can ensure good outcomes.
胆石性肠梗阻是机械性小肠梗阻的罕见病因，占病例的1%-4%，最常见于老年女性。它是由一颗大的胆结石通过胆囊-肠瘘进入肠腔，通常嵌顿在回肠末端导致梗阻引起的。
一名52岁男性因腹痛、呕吐、腹胀和便秘四天前来就诊。他有22年的胆结石病史，但之前没有胆道症状。影像学检查显示小肠梗阻，伴有胆囊-十二指肠瘘，一颗3.5厘米的胆结石嵌顿在回肠。他接受了成功的开放式肠石切除术，恢复顺利。
胆石性肠梗阻通常影响老年女性，因为胆结石和慢性胆囊炎的患病率较高。胆结石的危险因素包括肥胖、糖尿病和吸烟，该患者均无这些因素。就诊延迟可能归因于认识不足、获得医疗服务受限以及既往无症状。腹部CT是诊断胆石性肠梗阻的金标准，优于X线和超声，可显示里格勒三联征——气腹、异位结石和梗阻。手术选择包括单纯肠石切除术或联合胆囊切除术和瘘修补术。对于病情稳定的患者，由于发病率较低，首选单纯肠石切除术。
即使在非典型人群中，肠梗阻时也应怀疑胆石性肠梗阻。及时诊断和微创外科治疗可确保良好预后。
