# Gallstone Ileus as an Uncommon Etiology of Intestinal Obstruction: A Case Report

## TL;DR

A 46-year-old woman with no prior gallbladder issues developed intestinal blockage from a large gallstone, highlighting the rare but possible occurrence of gallstone ileus.

## Contribution

This case report presents an unusual instance of gallstone ileus in a patient without a history of biliary disease.

## Key findings

- A large gallstone caused small bowel obstruction in a 46-year-old woman with no prior biliary disease.
- Enterolithotomy was safely performed to remove the gallstone, resulting in an uneventful recovery.
- The case underscores the need to consider gallstone ileus in patients with intestinal obstruction, even without a history of gallbladder issues.

## Abstract

Although gallstones are commonly confined to the biliary system, in rare instances, they may migrate into the intestinal tract and cause obstruction, a scenario most often observed in older adults with a history of gallbladder pathology. We describe the case of a 46-year-old woman who developed small bowel obstruction secondary to a large impacted gallstone, despite having no prior biliary disease. Her clinical presentation included a 15-day history of abdominal pain, bilious vomiting, and diarrhea. Laboratory tests revealed leukocytosis and acute kidney injury. Contrast-enhanced computed tomography demonstrated pneumobilia, small bowel obstruction, and a radiopaque ectopic gallstone. Exploratory laparotomy confirmed a 4 × 3 × 4 cm gallstone impacted 30 cm proximal to the ileocecal valve, which was successfully extracted via longitudinal enterotomy. The postoperative recovery was uneventful. This case illustrates the diagnostic and surgical challenges posed by gallstone ileus and emphasizes the importance of considering this condition even in patients without prior biliary pathology. Enterolithotomy proved to be a safe and effective treatment in this setting.