Abstract
In cases of spontaneous fistula closure such as reported here, surgical gallstone ileus should be managed carefully, especially in elder and high–risk subjects.
A 79–year–old Japanese man with a history of abdominal aortic aneurysm, dissecting thoracic aorta aneurysm, and cholecystolithiasis referred for abdominal pain and vomiting. Abdominal X–ray and computed tomography (CT) showed intestinal obstruction due to aberrant gallstone and pneumobilia. The diagnosed was gall stone ileus based on these findings, necessitating surgery. The gall bladder adhered firmly to the omentum and the duodenum as confirmed by laparoscopy. Given the man′s comorbidity, age, and surgical risk, enterolithotomy from the ileum alone was done. Gastroduodenal endoscopy showed a large fistula at the anterior duodenal wall with bile excretion. The fistula closed spontaneously asymptomatically and without complications 4 months postoperatively.
