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Case Reports
. 2014 Jan 3:2014:bcr2013201652.
doi: 10.1136/bcr-2013-201652.

Large bowel obstruction due to gallstones: an endoscopic problem?

Peter Waterland  1 , Faisal Shehzaad Khan, Damien Durkin
Affiliations
Case Reports

Large bowel obstruction due to gallstones: an endoscopic problem?

Peter Waterland et al. BMJ Case Rep. .

Abstract

A 73-year-old man was admitted with symptoms of large bowel obstruction. An emergency CT scan revealed pneumobilia and large bowel obstruction at the level of the rectosigmoid due to a 4×4 cm impacted gallstone. Flexible sigmoidoscopy confirmed the diagnosis but initial attempts to drag the stone into the rectum failed. An endoscopic mechanical lithotripter was employed to repeatedly fracture the gallstone into smaller fragments, which were passed spontaneously the next day. The patient made a complete recovery avoiding the potential dangers of surgery. This case report discusses cholecystoenteric fistula and a novel minimally invasive treatment for large bowel obstruction due to gallstones.

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Figures

Figure 1
Figure 1
A plain abdominal radiograph showing large bowel obstruction.
Figure 2
Figure 2
An axial CT slice demonstrating the obstructing gallstone lying within the pelvis.
Figure 3
Figure 3
A coronal CT slice demonstrating the obstructing gallstone with more proximal calculi visible.
Figure 4
Figure 4
Gallstone encircled by the lithotripter.
Figure 5
Figure 5
Lithotripter fragmenting the gallstone.
Figure 6
Figure 6
The obstructing gallstone and fragments.
See this image and copyright information in PMC

References

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