Gallstone Ileus at the Ligament of Treitz

Abstract

Introduction: Gallstone ileus is an uncommon cause of mechanical intestinal obstruction resulting from the passage of a gallstone into the intestinal lumen, typically via a bilioenteric fistula.

Objective: To report a clinical case of a patient with gallstone ileus caused by a cholecystoduodenal fistula, with the gallstone impacted at the ligament of Treitz.

Case Report: An 84-year-old female patient with a history of arterial hypertension and type 2 diabetes mellitus presented to the Center for Medical-Surgical Research (Centro de Investigaciones Médico Quirúrgicas) as an emergency with a sudden loss of consciousness and loss of muscle strength on the right side of her body. She was admitted with a chief complaint of emetic syndrome and an ongoing cerebrovascular event. Forty-eight hours after admission, a non-contrast abdominal computed tomography (CT) scan was performed, leading to a diagnosis of gallstone ileus secondary to a cholecystoduodenal fistula, with the stone impacted at the ligament of Treitz. An urgent therapeutic upper endoscopy was attempted under anesthesia, due to the patient's high surgical risk, but proved ineffective. Ultimately, an enterolithotomy was performed.

Conclusions: Gallstone ileus is a condition typically seen in older adults, who often present with concomitant comorbidities. The ability to establish a preoperative diagnosis of this condition directly contributes to a reduction in complications.