Gallstone illeus in postpartum: a case report

Introduction: Biliary ileus is a rare complication of cholelithiasis in which gallstones obstruct the intestine due to anomalous communication between the intestine and the gallbladder. Gallstone ileus is more common in patients over 70 years old, particularly in women with other comorbidities. On the other hand, the risk of gallstone formation increases during pregnancy due to hormonal changes. Symptoms include abdominal pain, vomiting, and intermittent obstruction. Diagnosis is established through history-taking, physical examination, and imaging tests. Treatment involves surgery to solve intestinal obstruction and remove the gallbladder. Thus, this is a challenging condition that necessitates a careful approach. Objectives: To identify the physiopathological characteristics of biliary ileus in young patients postpartum which commonly do not present this type of condition. Additionally, discuss clinical symptoms, diagnosis, treatment, and surgical outcomes. Method: Case report conducted through review of medical record and examinations of a postpartum patient with biliary ileus. Results: Female patient, 35 years old, 30 days of postpartum, presenting duodenal obstruction symptoms. Abdominal tomography revealed a radiopaque ectopic image accompanied by intestinal hydroaerial distension, suggesting a gallstone in the duodenum. Patient underwent enterotomy with primary closure associated with cholecystoenteric fistula repair and cholecystectomy. Conclusion: Biliary ileus is more common in the elderly women. Diagnosis is achieved through imaging tests, especially computed tomography. The primary treatment aims to remove the stone, relieving intestine obstruction in the least invasive approach. In high surgical risk patients, endoscopic treatment should be considered, which may require multiple approaches and have its limitations. The surgical approach is conducted in one or two surgeries, depending on the patient's condition. In conclusion, imaging studies combined with clinical assessment are of great importance for diagnosing this pathology, and the treatment involves enterotomy, fistula repair, and cholecystectomy in a single surgical session proved to be an excellent option but continues to be questioned in patients with an important surgical risk.