Laparoscopic enterolithotomy is a valid option to treat gallstone ileus

Abstract

Gallstone ileus is a well-recognized clinical entity. It usually affects elderly female patients, and very often diagnosis can be delayed resulting in high morbidity and mortality. An abdominal x-ray and computed tomographic (CT) scan of the abdomen may show classical radiological features of small bowel obstruction, pneumobilia, and an ectopic gallstone. Laparotomy and enterlithotomy with or without definite biliary surgery is an established treatment. Since 1992, many cases of laparoscopic-assisted enterolithotomy have been reported. Only a few cases of a totally laparoscopic approach have been documented. We present the case of a 75-year-old lady who presented with features of intestinal obstruction. A plain x-ray of the abdomen and a CT scan confirmed the classical features of gallstone ileus. A totally laparoscopic enterolithotomy was performed using 6 ports. A 6-cm gallstone was retrieved through a longitudinal enterotomy. The transverse closure of the enterotomy was performed with intracorporeal suturing, resulting in an uneventful postoperative recovery. We suggest that a CT scan helps in the early diagnosis of the cause of intestinal obstruction, and totally laparoscopic enterolithomy with intracorporeal enterotomy repair is a valid, safe option.

Figure 1.

A stone in dilated small bowel and collapsed small bowel.

Figure 2.

Stone coming out through the enterotomy.

Figure 3.

Intracorporeal transverse repair of the enterotomy.

Figure 4.

A 6-cm stone coming out of the enterotomy.

Figure 5.

Air in billiary tract.

Figure 6.

Dilated small bowel loops with large gallstone.

Figure 7.

Air in common bile duct and gallstone in distal small bowel.