Gallstone ileus of the sigmoid colon: a rare complication of gallbladder calculosis typical of advanced age. Report of a case

Sigmoid colon gallstone ileus is a mechanical large bowel obstruction caused by a biliary stone which migrates into the colon through a cholecysto-enteric fistula and gets impacted in the sigma. It is a very rare complication of gallbladder calculosis in the general population, but its frequency increases with age, with elderly people being the most frequently affected. Diagnosis is often delayed because of the prevalent symptom aspecificity, and the choice of the optimal surgical treatment is still debated, especially as the elderly have increased operative risk also due to multiple comorbidities. The most frequently employed procedures are: the enterolithotomy alone, aimed at just removing the obstacle and solving the occlusion; the one-stage procedure, where enterolithotomy, cholecystectomy and fistula repair are performed in the same operation, and the two-stage procedure, where enterolithotomy is performed first and cholecystectomy at a later stage. We report the case of a sigmoid colon gallstone ileus in an 81 year-old female patient with multiple comorbidities, who was treated with enterolithotomy alone-with residual gallbladder stone-to minimize the operating time and risk. A successful outcome of the intervention performed in our case is reported at a 1-year follow-up, the patient was in a good clinical status at the medical checks performed and had experienced no recurrences of ileus and no new pain symptoms from the gallbladder. The case and its outcome are discussed in the light of the background literature on pathogenesis, symptomatology, diagnosis and treatment of sigmoid colon gallstone ileus.