Natapat Chaisidhivej, MD, Jessica Larson, MD, Pratiksha Moliya, MD, Kevin Brittan, MD, Alexandra MacBride, MD, Shailender Singh, MBBS University of Nebraska Medical Center, Omaha, NE Introduction: Gallstone ileus is a rare complication of gallstone disease causing bowel obstruction, with a prevalence ranging from 0.3% to 1%. It occurs when a gallstone passes from the biliary tract and obstructs the gastrointestinal tract at a point narrower than its diameter, most commonly in the small intestine (over 80% of cases). The most frequent etiology is a cholecystoenteric fistula. We report a rare case of gallstone ileus causing large bowel obstruction that was successfully resolved with endoscopic intervention.
Case Description/
Methods: A 76-year-old male with type 2 diabetes and a recent history of cholecystitis treated with antibiotics (with outpatient cholecystectomy planned) presented with a 2-day history of abdominal fullness, poor appetite, nausea, and vomiting. Physical examination revealed moderate abdominal distension, increased bowel sounds, and mild tenderness in the right lower quadrant. Laboratory studies showed leukocytosis (white blood cell count 19,200/mm³) and elevated serum creatinine (1.33 mg/dL). Abdominal computed tomography (CT) demonstrated gas and fluid distention throughout the small and large intestines, with a 4 cm ovoid hypoattenuating structure within the proximal sigmoid colon, consistent with an obstructing gallstone (Figure 1). Tethering of the proximal duodenum to the gallbladder neck suggested an underlying cholecystoduodenal fistula. These findings confirmed gallstone ileus at the sigmoid colon. The patient underwent urgent sigmoidoscopy by the surgical team, revealing a large stone completely obstructing the lumen with ulcerated underlying mucosa (Figure 2). Initial attempts at removal were unsuccessful. Repeat colonoscopy performed by the gastroenterology team included balloon-assisted dislodgment and mechanical lithotripsy, which also failed. Ultimately, the stone was removed using a Trapezoid basket, and mechanical lithotripsy successfully fragmented the stone into smaller pieces (Figure 3). The patient remained stable after the procedure, and cholecystectomy was planned on an outpatient basis. Discussion: Gallstone ileus causing colonic obstruction is extremely rare, and endoscopic management is challenging, requiring experienced endoscopists. This minimally invasive approach can reduce hospital stay and prevent morbidity and mortality, especially in elderly patients with significant comorbidities. Surgical backup should be readily available due to the potential difficulty of endoscopic removal.
Figure: Figure 1: Abdominal CT; Figure 2: Obstructing gallstone ileus in the sigmoid colon; Figure 3: Fragmented stone pieces after lithotripsy
Disclosures: Natapat Chaisidhivej indicated no relevant financial relationships. Jessica Larson indicated no relevant financial relationships. Pratiksha Moliya indicated no relevant financial relationships. Kevin Brittan indicated no relevant financial relationships. Alexandra MacBride indicated no relevant financial relationships. Shailender Singh indicated no relevant financial relationships.
Natapat Chaisidhivej, MD, Jessica Larson, MD, Pratiksha Moliya, MD, Kevin Brittan, MD, Alexandra MacBride, MD, Shailender Singh, MBBS. P2521 - Large Stone in the Colon! a Rare Case of Gallstone Ileus Causing Intestinal Obstruction, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
