# Management of a Large Bowel Obstruction Secondary to a 5cm Gallstone in a Rural Setting: A Case Report

## TL;DR

A rare case of large bowel obstruction caused by a 5cm gallstone in a rural area is presented, emphasizing the importance of surgical treatment.

## Contribution

This case report highlights the management of a rare colonic gallstone ileus with a cholecysto-colonic fistula in a rural setting.

## Key findings

- A 5cm gallstone caused large bowel obstruction with a cholecysto-colonic fistula and perforation.
- Endoscopic retrieval failed, leading to a Hartmann's procedure for treatment.
- Operative management is crucial for treating colonic gallstone ileus in rural areas.

## Abstract

We present a case of a large bowel obstruction secondary to a large impacted gallstone measuring 5cm in the sigmoid colon. Significant features include a cholecysto-colonic fistula and the presence of a perforation initially missed on imaging. Endoscopic retrieval was attempted, followed by a Hartmann's procedure. This case highlights the significance of operative management in ensuring the safe treatment of colonic gallstone ileus, especially in a rural setting.