Rare Presentation of Gallstone Ileus with One Stage Laparoscopic Management; the Tragedy, the Comedy and the Solution. Case Report

Abstract Introduction: Gallstone ileus is one of the rare complications of gallbladder stones and is a comparatively unique trigger of alimentary tract obstruction. It involves the development of a cholecystoenteric fistula through which a gallstone has passed into the gastrointestinal tract. Spontaneous resolution of intestinal obstruction in gallstone ileus is extremely rare.Case presentation: We present a case of a 71-year-old female patient presented by right hypochondrial pain for 4 months. Patient gave history of absolute constipation and abdominal distention 2 months before presentation that lasted for 3 days and resolved spontaneously. Imaging showed gallbladder stone and pneumobilia. Laparoscopic exploration showed a cholecysto-duodenal fistula that was divided, opening in the first part duodenum was closed directly in double layers and cholecystectomy was completed successfully.Conclusion:Presence on pneumobilia in patient with gallstones should raise suspicion of fistula between biliary tree and gut. Obstruction component of gallstone ileus can resolve spontaneously in rare occasions. Single stage laparoscopic management of cholecysto-duodenal fistula is safe and feasible in presence of experienced HPB laparoscopic surgeon.