Recurrent Gallstone Ileus : case report and literature review

The gallstone ileus is a rare complication of cholelithiasis (2) and it represents the 1-4% of small intestine mechanical obstruction. This particular pathology, as described for the first time in 1654 by Bartolini, consists of mechanical obstruction of the bowel lumen by a gallstone. Usually the gallstone is wedged in the terminal ileum, even if unusual locations to duodenojejunal flexure(1-7) have been described. Clinically, gallstone ileus presents acute abdominal pain and vomiting. From a radiological point of view there is the pathognomonic triad composed of pneumobilia, small bowel obstruction and ectopic gallstone (6). The morbidity and mortality of this disease, remain very high, often because of misdiagnosis or delayed diagnosis (4). In fact, the average duration of symptoms is 6 days (range 2-14) with an average diagnostic delay of 3.5 days (range 1-10) (5). The choice between one-time surgical procedure and surgery at two times is often difficult: in literature there is no unique opinion on this. The majority of the authors prefers the enterolithotomia and cholecystectomy surgery with cholecysto-duodenal fistula repair; others indicate first the enterolithotomia surgery followed by cholecystectomy and fistula repair. We consider useful to present a clinical case that summarizes the diagnostic and therapeutic difficulties of gallstone ileus.