Case Study: An Uncommon Jejunal Gallstone Ileus That Was Nearly Overlooked
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By
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Chengyang Chen
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Yushi Fan
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Baoping Tian
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Hui Shan
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Nanxia Xuan
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Linlin Du
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Gensheng Zhang
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August 18, 2026
Clinical Scorecard: Case Study: An Uncommon Jejunal Gallstone Ileus That Was Nearly Overlooked
At a Glance
| Category | Detail |
|---|
| Condition | Gallstone Ileus |
| Key Mechanisms | Mechanical intestinal obstruction due to gallstone migration through a cholecystoduodenal fistula. |
| Target Population | Elderly patients, particularly those with a history of cholelithiasis. |
| Care Setting | Emergency department and surgical intervention. |
Key Highlights
- Gallstone ileus is a rare cause of intestinal obstruction, especially in the jejunum.
- Diagnosis can be challenging due to poorly visualized gallstones on imaging.
- Rigler’s triad (pneumobilia, small bowel obstruction, and cholecystoduodenal fistula) is critical for diagnosis.
- Emergency exploratory laparotomy is often required for definitive treatment.
- Postoperative complications can occur, such as transient atrial fibrillation.
Guideline-Based Recommendations
Diagnosis
- Utilize contrast-enhanced CT for identifying gallstone ileus.
- Consider Rigler’s triad in patients presenting with intestinal obstruction.
Management
- Emergency laparotomy and enterolithotomy are recommended for obstructive cases.
Monitoring & Follow-up
- Postoperative monitoring for complications such as arrhythmias and hypotension.
Risks
- Delayed diagnosis can lead to increased morbidity and mortality.
Patient & Prescribing Data
Older adults with gallstone disease.
Surgical intervention is often necessary, and postoperative care should include monitoring for arrhythmias.
Clinical Best Practices
- Ensure effective communication between clinicians and radiologists.
- Conduct structured follow-up for patients with suspected gallstone ileus.
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