Journal of Clinical Care and Skills

en Repair of a Rare Case of Ileus Gallstone Cholecystoduodenal Fistula with Gastroduodenal Anastomosis Intensive and Emergency Care Intensive and Emergency Care گزارش مورد/موارد Case/Series Report Aims: This study reported a rare case of gallstone ileus associated with a cholecystoduodenal fistula and describe its diagnosis and surgical management. Patients & Methods: A 66-year-old man with no history of illness or surgery presented to a hospital in Shiraz with abdominal pain, bloating, nausea, vomiting, severe constipation, and an inability to pass gas or stool for 5 days. Ultrasound revealed a fistula between the gallbladder and duodenum. The patient had stable vital signs, abdominal distension, and slight tenderness without guarding or rebound tenderness. A CT scan of the abdomen and pelvis with oral contrast demonstrated an obstructive pattern, and the patient became a candidate for surgery. Findings: Exploratory laparotomy revealed a 2×2cm gallstone at the end of the ileum, causing proximal dilation and distal collapse extending to the cecum. A 1×1cm fistula was detected between the initial part of the duodenum and the gallbladder, along with a 3×3cm stone in the gallbladder infundibulum. Cholecystectomy was performed, followed by removal of the first part of the duodenum and attachment of the second part of the duodenum to the gastroduodenal anastomosis. An enterotomy was performed, and the ileal stone was removed. On the fourth postoperative day, the patient tolerated a diet and passed gas and stool normally. He was discharged on the fifth day in good general condition, with normal test results. Conclusion: Gallstone ileus can cause severe obstruction, so timely diagnosis and a detailed medical history are essential for surgical planning.   Gallstones, Ileus , Cholecystoduodenal Fistula, Anastomosis, Surgical 113 116 http://jccs.yums.ac.ir/browse.php?a_code=A-10-441-1&slc_lang=en&sid=1 M.H. Niakan No “Trauma Research Center” and “Shahid Rajaee (Emtiaz) Trauma Hospital”, Shiraz University of Medical Sciences, Shiraz, Iran S. Gheysari Yes Department of Operating Room Technology, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran M. Hasanshahi No Department of Operating Room Technology, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran E. Kuhsari No Department of General Surgery, School of Medicine, Shiraz University of medical Sciences, Shiraz, Iran A.H. Yousefinya No Department of Anesthesiology, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran