A 73-year-old man with
gallstone disease was admitted with right upper quadrant
abdominal pain. He was treated for
cholecystitis with intravenous
antibiotics. Two days later, he reported of new onset left iliac fossa
pain, with tenderness and guarding. An abdominal X-ray demonstrated small bowel obstruction, a CT scan demonstrated an impacted
gallstone within the proximal ileum. He was treated for a
gallstone ileum and underwent an uncomplicated
laparotomy, small bowel enterotomy and removal of a faceted
gallstone. Three months later, the patient re-presented with generalised
abdominal pain, guarding and rebound tenderness. Small bowel obstruction was again demonstrated with an impacted
gallstone within the distal ileum seen on CT scan. A second
laparotomy revealed two further faceted
gallstones, which were removed through an enterotomy. The densely adherent gallbladder to the duodenum precluded a surgical repair of the
cholecystoduodenal fistula. He made an uneventful recovery and was subsequently discharged home.