Gallstone ileus caused by a gallstone impacted at a cecum neoplasm – A case report

Highlights • Gallstone ileus is an infrequent complication of biliary disease. • We present a unique case of gallstone ileus due to a gallstone impacted in a cecum tumor.
Background Gallstone ileus is an infrequent complication of biliary disease that produces a mechanical intestinal obstruction. It is caused by a gallstone passing through a bilio-digestive communication, usually a cholecystoduodenal fistula. The presence of neoplasms can decrease the bowel lumen size and may cause the gallstone to impact at the narrowing site. Case summary In this report, we present a unique case of gallstone ileus due to a gallstone impacted in a cecum tumor, causing obstruction at the level of the ileocecal valve. The patient needed an urgent right hemicolectomy to solve both his problems. The gallbladder and the enterobiliary fistula remained in situ. Discussion The clinical presentation is not always straightforward and sometimes the diagnosis is only made by imaging, mostly resorting to an abdominal CT. The mainstay of management is surgical relief of the gastrointestinal obstruction, with the surgical method being based on what is found intra-operatively and according to the patient general condition. Conclusion Although a rare disease, gallstone ileus should be suspected in elderly patients with intestinal obstruction and a previous history of biliary problems, keeping in mind that other conditions may be present and can alter the surgical treatment of choice.