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Background: Gallstone impaction, which is the result of gallstone migration into the digestive tract through a biliaryenteric fistula, is a well-known but rare cause of mechanical ileus. In this report, we describe an interesting case of gallstone ileus, in which surgical intervention was eventually necessary due to a delay in stone evacuation, and spontaneous closure of the biliary-enteric fistula occurred early after enterolithotomy. Case presentation: A 61-year-old woman was referred to our hospital for the treatment of vomiting. Computed tomography revealed a distended upper gastrointestinal tract, pneumobilia, and impaction with an oval mass measuring 3.2 × 2.5 cm in size within the intestinal lumen, leading to a diagnosis of gallstone ileus. The patient was initially treated conservatively with volume resuscitation, continuous hemodialysis for acute renal failure, and an ileus tube. Although the patient’s condition improved, evacuation of the stone was not observed 5 days after admission. The patient then underwent enterolithotomy and the initial diagnosis was confirmed surgically. The postoperative course was uneventful and follow-up endoscopy revealed spontaneous closure of the biliary-enteric fistula. Conclusion: Spontaneous resolution of gallstone ileus after conservative treatment has been increasingly reported. However, our experience suggests that swift transition to surgical intervention is necessary when conservative treatment is not effective. Although spontaneous closure of the fistula may occur early after enterolithotomy, long term result, including cancer development, remains unknown.

Lessons learnt from a case of enterolithotomy for gallstone ileus of the jejunum