Abstract
Objective: To show the importance of considering the gallstone ileus as a cause of acute obstructive abdomen. Case details: Male patient, 77 years old, admitted in hospital unit with complaints of abdominal pain and distension, vomiting and constipation. Cholelithiasis diagnosed 2 years ago, without treatment. CT scan of the abdomen and pelvis identified hydroaereal distension of small intestine loops and dilation with retention of feces and colon fluids upstream of a rounded configuration, with heterogeneous density, located in the proximal portion of the sigmoid, with 3.3 cm in the largest diameter. Presence of diverticula along the colon, giving a spiky aspect to the intestinal walls, parietal hypertrophy and luminal reduction. Air in the region of the gallbladder as well as in the bile ducts and choledochus. Well-defined fistulous tract between the hepatic angle of the colon and the bed of the gallbladder. Closed diagnosis of acute obstructive abdomen due to gallstone ileus of the sigmoid colon. A laparotomy was performed with cholecystectomy and colectomy in the middle third of the transverse colon. Final considerations: The colonic gallstone ileus is a rare cause of mechanical obstruction of the large intestine, usually caused by impaction of gallstones at the point of colonic narrowing. Surgery is the basis of treatment.