Abstract
A 76-year-old woman presented with nausea, abdominal pain, and distention. She had undergone endoscopic sphincterotomy due to common bile duct calculi, but did not undergo subsequent cholecystectomy. Computed tomography showed pneumobilia and a low-density area in the sigmoid colon, above which the bowels were dilated. We diagnosed gallstone ileus and the impacted stone was removed endoscopically. The calculus seemed to have passed through a cholecystocolonic fistula. Cholecystectomy and partial colectomy were performed, revealing a cholecystocolonic fistula with severe fibrosis and inflammatory changes around the gallbladder. The specimen was revealed to contain gallbladder cancer, which had invaded the subserosa in the body but did not extend to the fistula. No recurrence has been seen as of one year after surgery. Gallstone ileus is a disease that predominantly affects elderly women and, because of their comorbidities, enterotomy with stone extraction alone is the first surgical choice for this disease. However, since concomitant gallbladder cancer and cholecystoenteric fistulas are not easily ruled out, biliary surgery for such fistulas should be performed in case the condition of the patient proves acceptable.
