{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T08:54:20Z","timestamp":1772268860003,"version":"3.50.1"},"reference-count":12,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,2,15]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>Cholecystoenteric fistulas are uncommon complications of chronic gallstone disease and may present insidiously, leading to delayed diagnosis. We describe a male patient in his early 70s who developed biliary ileus secondary to a cholecystoduodenal fistula, initially manifesting as right upper quadrant pain, bilious vomiting and progressive oral intolerance. CT imaging demonstrated pneumobilia, a large ectopic gallstone and small-bowel obstruction consistent with Rigler\u2019s triad. At laparotomy, he underwent partial cholecystectomy, closure of the duodenal defect, pyloric exclusion and decompressive procedures; however, an enteric leak required reoperation with omental patch repair, gastrojejunostomy and enterolithotomy. His recovery was complicated by intra-abdominal sepsis and ventilator-associated pneumonia but improved with intensive care management.<\/jats:p>\n                  <jats:p>This case highlights the diagnostic challenge of gallstone ileus from cholecystoduodenal fistula and the need for prompt CT evaluation and flexible, staged surgical decision-making in patients with significant inflammation or postoperative complications.<\/jats:p>","DOI":"10.1136\/bcr-2025-271613","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T05:05:11Z","timestamp":1772255111000},"page":"e271613","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Atypical operative sequence in Barnard\u2019s syndrome: managing gallstone ileus after biliary reconstruction"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2174-1866","authenticated-orcid":false,"given":"Ketzarly Gitzelim","family":"Gallardo Dur\u00e1n","sequence":"first","affiliation":[{"name":"Cirugia General, Instituto Mexicano del Seguro Social, Coahuila, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9746-7800","authenticated-orcid":false,"given":"Adrian Emanuel","family":"Aranda Chavez","sequence":"additional","affiliation":[{"name":"Cirugia General, Instituto Mexicano del Seguro Social, Coahuila, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2078-8910","authenticated-orcid":false,"given":"Rodolfo Julio","family":"Castell\u00f3 Magallanes","sequence":"additional","affiliation":[{"name":"Cirugia General, Instituto Mexicano del Seguro Social, Coahuila, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martha Eugenia","family":"Mart\u00ednez Romo","sequence":"additional","affiliation":[{"name":"General Surgery, Instituto Mexicano del Seguro Social, Durango, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"2026022721050557000_19.2.e271613.1","doi-asserted-by":"crossref","unstructured":"Ploneda-Valencia CF , Gallo-Morales M , Rinchon C , et al . Gallstone ileus: An overview of the literature. Rev Gastroenterol Mex 2017;248\u201354. doi:10.1016\/j.rgmx.2016.07.006","DOI":"10.1016\/j.rgmxen.2017.05.001"},{"key":"2026022721050557000_19.2.e271613.2","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-018-0271-6"},{"key":"2026022721050557000_19.2.e271613.3","unstructured":"Turner AR , Kudaravalli P , Al-Musawi JH , et al . Bouveret syndrome (bilioduodenal fistula). In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2025."},{"key":"2026022721050557000_19.2.e271613.4","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v8.i1.65"},{"key":"2026022721050557000_19.2.e271613.5","doi-asserted-by":"crossref","unstructured":"Browning LE , Taylor JD , Clark SK , et al . Jejunal perforation in gallstone ileus - a case series. 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Rolling Stones Management of Gallstone Ileus Through a Single-Institution Retrospective Analysis. 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