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Gallstone ileus is a rare complication of cholelithiasis which occurs in less than 1% of patients and is the cause of 1-
4% of cases of small bowel obstruction. The pathogenesis involves the formation of a bilioenteric fistula.
We report the case of gallstone ileus in an 81-year old woman with typical abdominal pain, arterial hypertension and
coronary artery disease. An abdominal computed tomography (CT) scan showed pneumobilia, dilated loops of small bowel
and an ectopic gallstone obstructing the intestinal lumen.
The patient underwent enterolithotomy and a 5-cm stone 20 cm from the ileocecal valve was removed. In the literature
enterolithotomy alone is the procedure most frequently used for gallstone ileus. Enterolithotomy plus cholecystectomy
and/or fistulectomy is only indicated in selected patients.
The clinical signs and symptoms depend on the site of the obstruction and usually include abdominal pain, nausea and
vomiting. The diagnostic test of choice is an abdominal CT scan.