Correspondence to Author: Marwan Mansour Burham ^1,2. 

1-Professor Of General Surgery, Faculty of Medicine, Al-Azhar University Cairo, Egypt.
2-Consultant Laparoscopic Surgeon at Prince Mohamed bin Salman Hospital Aden, Yemen

DOI: 10.52338/wjcsr.2026.5588

Abstract:

Background: Gallstone ileus is a rare but important cause of mechanical intestinal obstruction, accounting for approximately 1–4% of all cases. It occurs as a complication of cholelithiasis due to the formation of a cholecystoenteric fistula, allowing the passage of gallstones into the gastrointestinal tract. The terminal ileum is the most common site of impaction due to its narrow lumen and reduced peristalsis. The condition is more frequently encountered in elderly patients with multiple comorbidities and is associated with significant morbidity and mortality, particularly in cases of delayed diagnosis.
Case Presentation: A 61-year-old female with a medical history of poorly controlled type 2 diabetes mellitus, hypertension, ischemic heart disease, and previous abdominal surgeries (right nephrectomy and appendectomy) presented to the emergency department with a five-day history of abdominal pain, vomiting, abdominal distension, and constipation. Clinical examination revealed signs of dehydration and hemodynamic instability. Laboratory investigations showed elevated inflammatory markers and impaired renal function. Imaging with computed tomography confirmed the diagnosis of gallstone ileus, demonstrating features of intestinal obstruction and an ectopic gallstone in the ileum.
Intervention: Following initial resuscitation and optimization, the patient underwent laparoscopic exploration. Intraoperative findings included dilated small bowel loops and a transition point at the terminal ileum. Laparoscopic enterolithotomy was performed with successful extraction of a large gallstone measuring more than 3 cm in diameter, followed by primary closure of the enterotomy. A staged surgical approach was adopted due to the patient’s high operative risk, with interval cholecystectomy planned.
Outcome: The postoperative course was uneventful. The patient was monitored in the intensive care unit for 24 hours, followed by transfer to the surgical ward. She demonstrated good recovery and was discharged on the fourth postoperative day in stable condition without complications.
Conclusion: Gallstone ileus remains a diagnostic and therapeutic challenge, particularly in elderly patients with significant comorbidities. Computed tomography plays a pivotal role in early and accurate diagnosis. Laparoscopic enterolithotomy is a safe and effective minimally invasive option in selected patients, offering reduced morbidity, shorter hospital stays, and faster recovery compared to traditional open surgery.

Keywords: Gallstone ileus; intestinal obstruction; laparoscopic enterolithotomy; cholecystoenteric fistula; minimally invasive surgery; small bowel obstruction.

Citation:

Dr.Marwan Mansour Burham, Laparoscopic Management Of Gallstone Ileus: A Surgical Case Report. World Journal of Clinical Surgery 2026.