Highlights SIT is a rare congenital anatomy with mirror image transposition of the viscera. The underlying anatomical variation poses a challenge in the diagnosis and management of cholelithiasis In patient with SIT. Laparoscopic cholecystectomy can be safely performed in these cases. It is considered technically challenging procedure and often requires alteration in the technique compared to the conventional laparoscopic cholecystectomy.

Gallstone ileus is an uncommon complication of calculus cholecystitis through the formation of a biliary enteric fistula. The risk of mechanical obstruction caused by gallstones is increased with its size, in addition to chronic constipation, neoplasm and diverticulitis, to name a few. Here, we present a case of an 89-year-old male patient who presented with signs of bowel obstruction, which was found to be a gallstone impacted in the sigmoid colon. Considering the patient’s stable condition and his comorbidities, a conservative approach was opted including IV fluids, fleet enema and bowel rest. Colonoscopy was performed and confirmed the passage of the stone. With no consensus regarding the management, the literature emphasizes a tailored approach to each case considering all possible operative and non-operative approaches. Some reports show promising results with non operative management. Gallstone ileus remains a challenging case, and further studies for the best treatment modalities are needed.

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