Gallstone ileus of the sigmoid colon caused by cholecystocolonic fistula: A case report

INTRODUCTION: A cholecystocolonic fistula (CCF) is a late complication following repeated episodes of chronic inflammation of the gallbladder in contact with the hepatic flexure, and it might cause a biliary ileus in the colon, causing an intestinal obstruction, and if left untreated, a life threatening disease. PRESENTATION OF CASE: a 49-year-old female patient presented with abdominal pain and bowel obstruction due to a gallstone impaction on the sigmoid colon as consequence of a cholecystocolonic fistula. An enterolithotomy was performed, and the patient evolved favorably. She was discharged without complications on the 5th Postoperative day (POD). DISCUSSION: Clinical signs of CCF are usually minimal, and a preoperative diagnostic of CCF is rare, and it often presents with abdominal pain, nausea, vomiting, diarrhea, weight loss, and malabsorption. In the vast majority of patients presenting with CCF and biliary ileus, the stone is located within the sigmoid colon, accompanied with a concomitant disease at this point, with diverticulosis being the most common occurrence. CONCLUSION: A cholecystocolonic fistula with a gallstone colonic ileus must be suspected in an elderly, and female, patient presenting with cholelithiasis and with intestinal obstruction. Treatment should not be delayed, and correction of the intestinal obstruction ought to be the basis of the treatment.