title: Twice recurrent gallstone ileus: a case report.
abstract: BACKGROUND
  Gallstone ileus is a rare cause of bowel obstruction and results from the passage of gallstones into the bowel.
  
  
  METHODS
  We present the case of an 83-year-old Caucasian woman who had three episodes of gallstone ileus, each of which was managed with simple enterotomy. This sequence is one of the first reported in the medical literature and may be seen to challenge the traditional surgical approach of enterotomy alone.
  
  
  CONCLUSIONS
  The available evidence comparing enterotomy alone with combined enterotomy, cholecystectomy, and fistula closure in the management of gallstone ileus is reviewed. Neither approach is clearly identified as superior, but available series suggest that simple enterotomy may be safer than a combined approach and does not result in a higher rate of recurrent biliary disease.
authors.affiliation: Department of Surgery, Leighton Hospital, Middlewich Road, Crewe, Cheshire, CW1 4QJ, UK. rhystjones@gmail.com.
authors.forename: Rhys
authors.initials: R
authors.lastname: Jones
authors.forename: Daniel
authors.initials: D
authors.lastname: Broman
authors.forename: Richard
authors.initials: R
authors.lastname: Hawkins
authors.forename: David
authors.initials: D
authors.lastname: Corless