Gallstone ileus at the angle of Treitz
Keywords:
gallstone, fistula, tomographyAbstract
Introduction: Gallstone ileus is a rare cause of mechanical intestinal obstruction caused by the passage of a gallstone into the intestinal lumen, usually through a biliary-enteric fistula.
Objective: To present the clinical case of a patient with gallstone ileus due to a cholecystoduodenal fistula with a gallstone impacted in the angle of Treitz.
Clinical case: An 84-year-old female patient with a history of hypertension, type 2 diabetes mellitus, transient ischemic attacks, and dyspeptic symptoms associated with the ingestion of cholecystokinetic foods and intermittent episodes of vomiting containing food debris or bilious vomiting in the late postprandial period. She came to the hospital with bilious vomiting associated with loss of consciousness and muscle strength in the right side of the body. She was admitted with emetic syndrome and ongoing cerebrovascular disease. Forty-eight hours after admission, a simple abdominal computed tomography scan was indicated due to high output (approximately 1500 milliliters per day) through a nasogastric tube with biliary characteristics, which confirmed Rigler's triad. A diagnosis of gallstone ileus due to a cholecystoduodenal fistula with an impacted stone in the angle of Treitz was made. An emergency upper endoscopy was performed under anesthesia due to the patient's high surgical risk. This was not effective, but the stone was advanced to the jejunum and enterolithotomy was performed.
Conclusions: Gallstone ileus is a condition in older patients that typically presents with concomitant diseases. The ability to diagnose the condition preoperatively directly reduces complications, making ED care extremely important.
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Copyright (c) 2025 Luis Enrique Exposito Portales, Sheyla Moret Vara, Lissette Chao González, Kenia Yunarkis Valenzuela Aguilera, Dania Delgado Rivero, Amarilis Duarte Frenández
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