title: Bowel obstruction and perforation due to a large gallstone. A case report.
abstract: BACKGROUND
  Gallstone bowel obstruction is a rare form of mechanical ileus usually presenting in elderly patients, and is associated with chronic or acute cholecystitis episodes.
  
  
  METHODS
  We present the case of an 80year old female with abdominal pain, inability to defecate and recurrent episodes of diarrhea for the past 8 months. CT examination uncovered a cholecystoduodenal fistula along with gas in the gall bladder and the presence of a ≥2cm gallstone inside the small bowel lumen causing obstruction. Patient was admitted to the operating room, where a 3.2cm gallstone was located in the terminal ileus. A rupture was found in the antimesenteric part of a discolored small bowel segment, approximately 60cm from the ileocaecal valve, through which the gallstone was recovered. The bowel regained its peristalsis, and the rupture was debrided and sutured. Patient was discharged uneventfully on the 6th postoperative day.
  
  
  CONCLUSIONS
  Gallstone ileus is caused due to the impaction of a gallstone inside the bowel lumen. It usually passes through a fistula connecting the gallstone with the gastrointestinal tract. It can present with nonspecific or acute abdominal symptoms. CT usually confirms the diagnosis, while there are a number of treatment options; conservative, minimal invasive and surgical. Our patient was successfully relieved of the obstruction through recovery of the gallstone using open surgery, with no repair of the fistula.
  
  
  CONCLUSIONS
  Although rare, gallstones must be suspected as a possible cause of bowel obstruction, especially in elderly patients reporting biliary symptoms.
authors: 1st Department of Surgery, 401 Army General Hospital of Athens, Greece. Electronic address: sachsamanis@hotmail.com.
authors: Georgios
authors: G
authors: Sahsamanis
authors: 1st Department of Surgery, 401 Army General Hospital of Athens, Greece.
authors: Konstantinos
authors: K
authors: Maltezos
authors: Department of Radiology, 401 Army General Hospital of Athens, Greece.
authors: Panagiotis
authors: P
authors: Dimas
authors: 1st Department of Surgery, 401 Army General Hospital of Athens, Greece.
authors: Alexandros
authors: A
authors: Tassos
authors: 1st Department of Surgery, 401 Army General Hospital of Athens, Greece.
authors: Christos
authors: C
authors: Mouchasiris
keywords: Biliogastric fistula; Case report; Gallstone bowel obstruction; Gallstone ileus; Rigler’s triad