Abstract
Introduction Gallstone ileus is a very infrequent complication of cholelithiasis in which single
or multiple stones pass through an abnormal fistula to the lumen of the intestine
leading to a true mechanical obstruction. We are reporting a case of a female who
developed intestinal obstruction due to gallstones during the coronavirus disease
2019 (COVID-19) outbreak and was managed urgently surgically in a low-settings hospital.
Case Presentation An 85-year-old white female with 40 years history of gallstone disease, hypertension,
and type-2 diabetes presented to the accidents and emergency unit with upper central
crampy abdominal pain for 5 days associated with green color vomiting and absolute
constipation. On examination, she was barely stable, dehydrated, had a distended abdomen,
and guarding in the epigastric region. Her electrolytes were disturbed and had elevated
serum creatinine and blood urea. Imaging studies confirmed gallstone ileus. Management
was surgical despite the lack of facilities and equipment including COVID-19 personal
protective equipment.
Conclusion Despite being an infrequent complication, gallstone ileus might present at the most
unexpected time and in the least equipped hospital where the surgeon's suspicion,
risk stratification, and improvisation by utilizing what is available are the keys
for successful management and saving lives.
Keywords
surgical management - gallstone ileus - COVID-19 - low-settings hospital - case report
