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Case Report
Twin-Stone syndrome: A rare presentation of gallstone ileus
1 Department of Surgery, Cooper University Hospital, Camden, NJ, USA
2 Cooper Medical School of Rowan University, Camden, NJ, USA
Address correspondence to:
T N Hess
3 Cooper Plaza, Suite 411, Camden, NJ 08103,
USA
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Article ID: 100160Z12TH2025
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Hess TN, Brigando ON, Bailey DW. Twin-Stone syndrome: A rare presentation of gallstone ileus. J Case Rep Images Surg 2025;11(2):10–13.ABSTRACT
Introduction: Gallstone ileus is a rare cause of mechanical bowel obstruction resulting from gallstone migration through a cholecystoenteric fistula, most commonly impacting the ileocecal valve. Bouveret syndrome, a rare variant, involves gastric outlet obstruction from proximal impaction.
Case Report: We present the case of a 61-year-old female with a closed-loop obstruction caused by multiple impacted gallstones. Surgical management for this patient included enterotomy, cholecystectomy, pyloroplasty, common bile duct resection with hepaticojejunostomy, and closure of the cholecystoduodenal fistula. The patient recovered well with a short episode of post-operative atrial fibrillation.
Conclusion: This case of Twin-Stone syndrome highlights the complexity of treating gallstone ileus, particularly with more complicated sites of obstruction combined with fistula formation. Surgical management of this complex disease should be tailored to the patient’s clinical scenario to provide optimal outcomes in this high-risk population.
Keywords: Acute care surgery, Gallstone ileus, Small bowel obstruction
SUPPORTING INFORMATION
Author Contributions
T N Hess - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Olivia N Brigando - Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Daniel W Bailey - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 T N Hess et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
