An unusual cause of abdominal pain: gallstone ileus.

A 74-year-old Taiwanese woman with diabetes mellitus came to the emergency department with a 1-week period of diffuse abdominal pain. She had been followed for asymptomatic gallstone (Figure 1A). Physical examination showed diffuse tenderness of abdomen and plain film of abdomen revealed intestinal obstruction (Figure 1B). Total serum bilirubin was 0.6mg/dl, glutamate oxaloacetate transaminase 19 IU/l and amylase 35 IU/l. Computed tomography showed a large gallstone in small intestine resulting in obstruction (Figure 1C). A diagnosis of gallstone ileus was made and laparoscopy showed the stone impacted in the jejunum (Figure 1D), which was removed by enterolithotomy (Figure 1E). Gallstone is a rare etiology for symptomatic ileus, which frequently preceded by an episode of acute cholecystitis. The profound inflammatory process will result in adhesions. The progressed erosion of the gallstone through the gall bladder wall could form a cholecysto-enteric fistula, which allows the passage of the gallstone. Gallstone ileus accounts for 1–3% of mechanical obstruction of the small intestine. The majority of the reported cases were older than 65 year of age. Gallstone ileus in the elder patients, who have concomitant cardiovascular,