Report of two cases of gallstone ileus and literature review

Materials and methods Two female elderly patients (83 and 87 years old) recently came to our attention for a mechanical bowel obstruction. Their routine blood investigation revealed only high urea, creatinine and phosphates. Ultrasonography showed scleroatrophic lithiasic cholecistytis. The abdominal X-ray didn't show any sign of Rigler's triad, except for small bowel obstruction. Laparotomy displayed scleroatrophic lithiasic gallbladder firmly adherent to the second portion of duodenum with intense surrounding inflammation due to cholecystoduodenal fistula. Also a gallstone, measuring approximately 3 × 2 cm (case 1) and 6 × 5 cm (case 2), was found impacting the ileum. The surgical strategy, chosen according to the clinical status of these patients (ASA3) and the difficult identification of Calot's triangle, consisted in performing an enterolithotomy and cholecystostomy through a Petzer catheter, after removing multiple gallstones and biliary sludge.