Gallstone ileus in a young patient complicated by double biliary-enteric fistula: A rare case report

Background

Gallstone ileus is an uncommon complication of chronic cholecystitis, characterized by mechanical small bowel obstruction due to gallstone migration through a biliodigestive fistula. The occurrence of double biliary-enteric fistulas (e.g., cholecysto-duodenal and cholecysto-colic) is infrequent and presents additional diagnostic and surgical challenges.

Case presentation

A 41-year-old woman with no significant past medical history presented with progressive abdominal pain, distension, and cessation of bowel movements. Laboratory findings indicated a severe inflammatory response (CRP: 312 mg/L; leukocytosis: 13,000/mm³). CT imaging revealed jejuno-ileal distention with a calcified intraluminal mass suggestive of gallstone ileus and evidence of a cholecysto-duodenal fistula. Emergency laparotomy confirmed a large obstructing gallstone 30 cm from the ileocecal valve. Surgical exploration revealed two fistulas: cholecysto-duodenal and cholecysto-colic. The stone was removed via enterotomy; both fistulas were sutured, and a partial cholecystectomy was performed. The postoperative course was uneventful.

Discussion

Gallstone ileus typically affects older individuals, and its occurrence in a young patient is unusual. The presence of a double fistula is a rare complication that complicates surgical management. Early diagnosis via imaging and timely intervention are critical. In this case, a one-stage procedure involving enterotomy, fistula closure, and partial cholecystectomy was successfully performed.

Conclusion

This case underscores the diagnostic and surgical complexity of gallstone ileus, especially when associated with double biliary-enteric fistulas. It emphasizes the importance of individualized surgical planning and the utility of CT imaging in diagnosis.