Colonic Gallstone Ileus: A Rare Case

A 72-year-old woman with a history of atrial fibrillation, arterial hypertension, thyroidectomy, and mitral insufficiency presented to the emergency department with nausea, vomiting, and abdominal pain for the last 24 h. At physical examination, the patient had right upper abdominal pain and Murphy’s sign. Abdominal ultrasound revealed gallstones, thickened gallbladder wall, and sonographic Murphy’s sign. Blood tests showed normal liver tests and inflammatory parameters (INR 2.1). She was admitted for acute cholecystitis. Due to comorbidities, intravenous antibiotherapy was started and cholecystectomy was delayed until cardiac evaluation and anticoagulation correction. On the 6th day of hospitalization, the patient presented abdominal distension, hyperactive bowel sounds, and mild diffuse tenderness. CT scan demonstrated a thickened gallbladder wall with fistula to the colonic hepatic flexure, and a gallstone of 2.2 cm in the sigmoid colon causing proximal gas distension of the bowel (Fig. 1). Colonoscopy revealed an impacted gallstone at 30 cm from the anal verge and adjacent mucosal ulceration (2 ulcers of 5 mm). Attempted endoscopic removal with snare and basket was unsuccessful (Fig. 2). Due to colonic distension and higher surgical risk associated with the one-stage procedure, the patient underwent enterolithotomy and cholecystectomy was delayed and performed 2 months later, without complications.