title: [Gastrointestinal bleeding and delirium, challenges in the diagnosis of gallstone ileus: A case report and review of literature].
abstract: BACKGROUND
  Gallstone ileus is a non-strangulated mechanical obstruction of the small bowel or colon as a result of the passage of gallstones through a biliary enteric fistula. It is a rare complication of cholelithiasis, affects patients over 65 years, and the disease occurs predominantly in females. Preoperative diagnosis is difficult due to the lack of specific signs and symptoms in elderly patients with multiple comorbidities.
  
  
  METHODS
  A 93-year-old female presenting with a one-week history of upper gastrointestinal bleeding, electrolyte imbalance and community- acquired pneumonia pneumonia. During her prolonged hospital stay she presented an intestinal obstruction. The diagnosis of gallstone ileus was made by CT scan. Despite surgical treatment, she died due to late diagnosis.
  
  
  CONCLUSIONS
  Gallstone ileus is a rare pathology, difficulty in diagnosis prolongs hospital stay, which directly influences mortality.
authors.affiliation: Servicio de Cirugía General, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México. Electronic address: francisco_fae@msn.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Aguilar-Espinosa
authors.affiliation: Servicio de Inmunoalergología, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Gálvez-Romero
authors.affiliation: Servicio de Cirugía General, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México.
authors.forename: Jesús
authors.initials: J
authors.lastname: Falfán-Moreno
authors.affiliation: Servicio de Cirugía General, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México.
authors.forename: Gustavo Adolfo
authors.initials: GA
authors.lastname: Guerrero-Martínez
authors.affiliation: Servicio de Cirugía General, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México.
authors.forename: Facundo
authors.initials: F
authors.lastname: Vargas-Solís
mesh_terms: D000369:Aged, 80 and over; D015897:Comorbidity; D057210:Delayed Diagnosis; D003693:Delirium / Q000209:etiology*; D004381:Duodenal Ulcer / Q000150:complications; D017809:Fatal Outcome; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007077:Ileal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D045823:Ileus / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D007412:Intestinal Fistula / Q000150:complications / Q000000981:diagnostic imaging; D007579:Jejunal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D018805:Sepsis / Q000209:etiology; D014057:Tomography, X-Ray Computed
keywords: Delirium; Gallstone ileus; Gastrointestinal bleeding; Intestinal obstruction; Obstrucción intestinal; Sangrado de tubo digestivo; Íleo biliar