Gallstone Ileus Occurring 35 Years After Cholecystectomy in an Elderly Male
Bibliographic record
Abstract
Gallstone ileus occurring decades after cholecystectomy is exceptionally rare and represents an uncommon cause of small bowel obstruction (SBO) in elderly patients with prior gallstone disease. A 72-year-old male with a remote history of cholecystectomy presented with nausea, vomiting, and diffuse abdominal pain. CT imaging demonstrated an SBO with a calcified intraluminal mass in the distal ileum. After initial conservative management, the patient underwent exploratory laparotomy with extensive adhesiolysis, enterolithotomy, and primary ventral hernia repair. A large, calcified gallstone was removed from the distal ileum, confirming gallstone ileus. Postoperatively, the patient developed a transient superficial wound infection managed with bedside debridement and antibiotics, with full recovery and discharge on postoperative day ten. Gallstone ileus many years following cholecystectomy likely results from a persistent, chronically developed biliary-enteric fistula enabling delayed stone passage. Its nonspecific presentation and rarity can delay diagnosis, highlighting the importance of maintaining a high index of suspicion in elderly patients presenting with SBO and intraluminal calcified densities. This case emphasizes that gallstone ileus can occur long after cholecystectomy. Early recognition and timely operative intervention remain essential for optimal outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".