• E Spaziani, C Vergaro, M Picchio, A Di Filippo, F Ceci, E Faiola, M Ottaviani, F Parisella, A Martellucci, F Stefanelli, G Nardecchia, O Iorio, F De Angelis, B Cipriani, S Nicodemi, G Pattaro, and F Stagnitti.
• UOC Chirurgia Universitaria, Sapienza Università di Roma Polo Pontino, Ospedale A Fiorini, Terracina, AUSL Latina.
• G Chir. 2010 Jan 1; 31 (1-2): 28-32.

IntroductionGallstone ileus is a rare complication of cholecystolithiasis. It causes 1-3% of the mechanical obstructions of the small bowel. It often affects patients between 63 and 85 years old. Pre-operative diagnosis is usually delayed 1-10 days because there is not a specific symptomatology.Case ReportThe authors report the case of a 50 year-old man with diagnosis of mechanical obstruction of the small bowel caused by a voluminous gallstone. Ileal occlusion was showed by CT. The patient underwent to one-stage emergency surgery with enterolithotomy, cholecystectomy and duodenal fistula repair. Patient's recovery was regular and he was discharged fourteen days after surgery.DiscussionIn our case gallstone ileus was diagnosed with a delay of 5 days. Ultrasonography was not able to show the gallbladder. Diagnosis was made by CT, which is the diagnostic gold standard.ConclusionPatient's performance status influences surgical strategy. In our experience, the patient underwent one-stage surgery because he was considered at low risk. Instead staged procedure with enterolithotomy and delayed cholecystectomy and fistula repair, is performed only in patients at high risk.

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