Background:

Gallstone ileus is an infrequent cause of mechanical bowel obstruction, it is an unusual complication of cholelithiasis, occurring in less than 0.5 percent of patients who present with mechanical small bowel obstruction, affecting older adult patients. It is caused by impaction of a gallstone in the ileum after being passed through a biliary-enteric fistula. The diagnosis is often delayed since symptoms may be intermittent and investigations fail to identify the cause of the obstruction. The mainstay of treatment is removal of the obstructing stone.

Case report:

48-year-old man, with a 72-hour course characterized by: colicky abdominal pain of onset in the mesogastrium that at 24 hours became generalized, accompanied by progressive abdominal distension, nausea and vomiting. Physical: great abdominal distension, without peristalsis, generalized tympanism, on palpation generalized diffuse pain; with normal laboratories; tomography showed an increase in the diameter of the jejunal and proximal ileum loops, with thickening of the wall and abrupt change of gage in the ileum. At laparotomy was found an intestinal occlusive condition, secondary to the presence of a spherical biliary lithium with a diameter of 3 cm, at 120 cm. before ileocecal valve. Postoperative without complications.