Gallstone ileus: An unusual complication of cholelithiasis in a 42-year-old female with no comorbidities.

INTRODUCTION AND IMPORTANCE: Gallstone ileus is a rare condition, accounting for 0.5 % of mechanical small bowel obstructions. It is a misnomer for mechanical intestinal obstruction caused by one or more gallstones impacted within the gastrointestinal tract lumen, which occurs mostly in the elderly and female population. Treated usually by operative enterolithotomy. Preoperative diagnosis is challenging, but CT, which is investigation of choice, and magnetic resonance imaging (MRI) have made it easier to diagnose.

CASE PRESENTATION: A 42-year-old female presented to the emergency department with epigastric abdominal pain for 1 week, preceded by 2 months of RUQ pain. CT scan with contrast showed a classical finding of small bowel obstruction and ectopic gallstone. An emergency exploratory laparotomy, enterolithotomy, and cholecystectomy with fistula repair were performed in one surgical stage.

CLINICAL DISCUSSION: Laparoscopic enterolithotomy alone is the most preferred method due to its low incidence of complications but one-stage or two-stage surgeries are also options, but the choice between surgical modalities depends on the patient's status.

CONCLUSION: Gallstone ileus mostly affects older female patients who have a history of gallbladder disease and often have a poor prognosis that becomes worse with age and comorbidities. However, this was a young female patient with no comorbidities, which may affect the prognosis compared to those who are at risk for gallstone ileus.