Successful endoscopic treatment of colonic gallstone ileus using electrohydraulic lithotripsy

Abstract

The surgical management of gallstone ileus is complex and potentially highly morbid. Initial management requires enterolithotomy and is generally followed by fistula resection at a later date. There have been reports of gallstone extraction using various endoscopic modalities to relieve the obstruction, however, to date, there has never been a published case of endoscopic stone extraction from the colon using electrohydraulic lithotripsy. In this report, we present the technique employed to successfully perform an electrohydraulic lithotripsy for removal of a large gallstone impacted in the sigmoid colon. A cavity was excavated in an obstructing 4.1 cm lamellated stone in the sigmoid colon using electrohydraulic lithotripsy. A screw stent retractor and stent extractor bored a larger lumen which allowed for guidewire advancement and stone fracture via serial pneumatic balloon dilatation. The stone fragments were removed. Electrohydraulic lithotripsy is a safe and effective method to treat colonic obstruction in the setting of gallstone ileus.

Figure 1

Computed tomography. A: Gallstone impacted in the sigmoid colon; B: Pneumobilia.

Figure 2

Endoscopy images. A: Electrohydraulic lithotripsy (EHL) shock to the center of the gallstone; B: Soehendra screw retractor in place for dilation of the gallstone lumen.

Figure 3

Four gallstone fragments after balloon fracture.

Figure 4

Endoscopically assisted contrast evaluation of the cholecystocolonic fistula with cholelithiasis.