Laparoscopic management for gallstone ileus, case report

Abstract

Introduction: Gallstone ileus is a rare complication of cholelithiasis leading to small intestinal obstruction. Elderly females are commonly affected more than male. The diagnosis of this condition is challenging and Rigler's triad is pathognomonic. Surgery is mandatory with no clear consensus about the best surgical approach that should be adopted.

Case presentation: An elderly female patient, with no previous history of biliary diseases, presented with small bowel obstruction. Contrast enhanced computed tomography of the abdomen showed the classical Rigler's triad. Total laparoscopic enterolithotomy was performed successfully. She had smooth postoperative course and she was followed up regularly without occurrence of any biliary disease symptoms during the follow up period.

Conclusion: Gallstone ileus should be considered in differential diagnosis of small bowel obstruction mainly in old females with no previous history of abdominal surgery. Laparoscopic enterolithotomy is safe, feasible and effective when performed by experienced surgeons.

Keywords: Enterolithotomy; Gallstone ileus; Laparoscopy; Small bowel obstruction.

Fig. 1

CT abdomen showing the classical Rigler’s triad of GSI. The red arrow indicates the ectopic gallstones. The blue arrow indicates the pneumobilia. Also, notice the dilated small bowel loops.

Fig. 2

Intraoperative findings. A: Impacted gallstones were located using atraumatic clamps, B: Applying stay sutures for facilitation of bowel manipulation, C: Extraction of gallstones through enterotomy; notice the gallstones over the gauze and inside the bowel lumen, D: Closure of enterotomy transversely using Endo-stitch.