title: An Unusual Presentation of Gallstone Ileus: A Red-Herring or Missed Diagnosis.
abstract: BACKGROUND
  Gallstone ileus is a rare complication of chronic calcular cholecystitis and an uncommon etiological entity responsible for mechanical intestinal obstruction. The most common obstructed part is the narrow terminal ileum, whereas the jejunum is rarely affected. The gallstone is postulated to reach the small bowel by gradual erosion from the gall bladder, most commonly into the duodenum, forming a cholecysto-duodenal fistula.
  
  
  METHODS
  Herein, we report a 72-year-old male who presented with intestinal obstruction of a 5-day duration, with a clinical diagnosis of an irreducible inguinal hernia. However, the patient continued to be symptomatic following an uncomplicated hernioplasty. A computerized tomography (CT) scan of the abdomen revealed a small bowel lesion, which intra-operatively was confirmed to be an impacted gallstone in the jejunum with a cholecysto-duodenal fistula.
  
  
  CONCLUSIONS
  Despite gallstone is uncommon cause of intestinal obstruction, a high index of suspicion with a careful CT scan interpretation is the key to the diagnosis, especially when there is a red-herring distracting the attention, like irreducible hernia in this case.
authors.affiliation: Department of Surgery, Hamad General Hospital, Doha, Qatar.
authors.forename: Saif
authors.initials: S
authors.lastname: Al-Mudares
authors.affiliation: Department of Surgery, Hamad General Hospital, Doha, Qatar.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kurer
authors.affiliation: Department of Surgery, Hamad General Hospital, Doha, Qatar.
authors.forename: Renol M
authors.initials: RM
authors.lastname: Koshy
authors.affiliation: Department of Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Menyar
mesh_terms: D000368:Aged; D001658:Biliary Fistula / Q000150:complications; D042882:Gallstones / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D045823:Ileus / Q000175:diagnosis / Q000209:etiology*; D007412:Intestinal Fistula / Q000150:complications; D007415:Intestinal Obstruction / Q000209:etiology*; D007579:Jejunal Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male