Un caso di ileo biliare

Gallstone ileus is a rare complication of cholelithiasis caused by the impaction of one or more stones in the lumen of the gastrointestinal tract; pathophysiological prerequisite is the presence of a bilio-digestive fistula. The clinical signs and symptoms of intestinal obstruction, such as constipation, abdominal pain, nausea, vomiting and abdominal distension predominate, usually preceded by symptoms of acute cholecystitis. Plain abdominal X-ray, ultrasound and TC (gold standard) are cardinal for the diagnosis. Early diagnosis is a crucial point for the improvement of the prognosis, since this pathological condition is still characterized by an high morbidity and mortality burden. Treatment is surgical; currently most of the authors prefer a two-stage strategy. The case described below shows how diagnosis of gallstone ileus can be laborious and complex, requiring integration of more instrumental examination to reach the diagnosis as early as possible.