ABSTRACT

Background: Gallstone ileus is a rare cause of small‑bowel obstruction in elderly patients and may result from migration of large gallstones through a bilioenteric fistula. Mirizzi syndrome complicated by cholecysto‑enteric fistula (Mirizzi type V) may underlie such presentations and complicate operative planning.
Case presentation: A 76‑year‑old man with 15 years of insulin‑dependent type 2 diabetes presented after 6 days of progressive abdominal distension, obstipation and colicky pain without vomiting or fever. On examination he was hemodynamically stable; the abdomen was distended and tympanitic. Plain abdominal radiography demonstrated multiple small‑bowel air‑fluid levels. Contrast CT (24/03/2026) showed dilated small bowel with a distal ileal transition at two spontaneously hyperdense endoluminal oval bodies and intrahepatic branching gas (aeroportia); the gallbladder was not visualized. Laboratory tests showed leukocytosis and elevated CRP; creatinine was elevated on admission.
The patient underwent urgent laparotomy. Exploration revealed marked small‑bowel dilation with a 7‑cm macro‑calculus impacted in an ileal loop 4 m from the ligament of Treitz and 60 cm from the ileocecal valve; no macroscopic intestinal ischemia was seen. A cholecysto‑duodenal fistula (Mirizzi Vb) with a scleroatrophic gallbladder occluded by greater omentum was identified. Procedures performed: enterolith extraction via enterotomy with Heineke–Mikulicz enteroplasty; disconnection of the cholecysto‑duodenal fistula; Kehr (T)‑tube (Ch12) drainage of the common bile duct; directed Pezzer drainage of the duodenal fistula; mechanical duodenal exclusion and omega Roux (Jordan) gastrojejunostomy; placement of pre‑ and retro‑pedicular drains. No bowel resection was required.
Conclusion: This case illustrates gallstone ileus that revealed Mirizzi syndrome with cholecysto‑duodenal fistula. In elderly, comorbid patients a pragmatic combined strategy—rapid obstruction relief, controlled biliary drainage and protection of duodenal repair—can treat both obstructive and biliary pathology while limiting operative risk.

KEYWORDS

Gallstone ileus; Mirizzi syndrome; cholecysto‑duodenal fistula; aeroportia; enterolithotomy; Kehr tube

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Cite this article

Anas, P. E., Mahassin, D. R., & Mohammed, D. K. (2026). Small‑Bowel Obstruction Revealing Mirizzi Syndrome: Gallstone Ileus from a Cholecysto‑Duodenal Fistula with a 7‑Cm Ileal Enterolith in a 76‑Year‑Old Insulin‑Dependent Diabetic. INTERNATIONAL JOURNAL OF HEALTH & MEDICAL RESEARCH, 5(6), 533-536. https://doi.org/10.58806/ijhmr.2026.v5i6n02