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. 2022 Jan:90:106682.
doi: 10.1016/j.ijscr.2021.106682. Epub 2021 Dec 11.

Totally laparoscopic resolution of gallstone ileus: A case report

Nicolás H Dreifuss, Francisco Schlottmann, Antonio Cubisino, Alberto Mangano, Carolina Baz, Mario A Masrur

Totally laparoscopic resolution of gallstone ileus: A case report

Nicolás H Dreifuss et al. Int J Surg Case Rep. 2022 Jan.

Abstract

Introduction: Gallstone ileus is an uncommon complication of long-term cholelithiasis. Emergent operations for gallstone ileus are associated with high postoperative morbidity. When feasible, the minimally invasive approach might help to improve the postoperative outcomes.

Presentation of case: A 63-year-old female was admitted for abdominal pain and vomiting. Computed tomography (CT) scan showed a cholecystoduodenal fistula and a 5 × 3 cm gallstone in the jejunum causing obstruction. An emergent laparoscopy was performed, and a gallstone was found inside the jejunum 40 cm distal to the ligament of Treitz. The 5 cm gallstone was extracted through an antimesenteric enterotomy. The jejunum was then closed transversally using interrupted sutures. The postoperative course was uneventful, and the patient was discharged on postoperative day 3.

Discussion: Surgery is the mainstream treatment for gallstone ileus. Multiple operations and surgical approaches have been described: enterolithotomy (EL), one-stage surgery (EL, cholecystectomy, and fistula closure), bowel resection, and two-stage surgery (EL and delayed cholecystectomy with fistula closure). The choice of the procedure depends on the patient's characteristics, comorbidities, and experience of the surgical team.

Conclusion: In the emergency setting, a simple enterolithotomy with primary closure seems to be the optimal approach to solve the intestinal obstruction with low postoperative morbidity. The laparoscopic approach to gallstone ileus results in additional benefits for patients' recovery.

Keywords: Case report; Enterolithotomy; Gallstone ileus; Intestinal obstruction; Laparoscopic surgery.

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Conflict of interest statement

The authors have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Computed tomography of the abdomen showing pneumobilia and a fistulous track between the gallbladder and duodenum.
Fig. 2
Fig. 2
Computed tomography of the abdomen showing (A: coronal section, B: axial section) a 5 cm stone with peripheral calcifications obstructing the jejunum.
Fig. 3
Fig. 3
Intraoperative picture showing the enterotomy in the jejunum antimesenteric border (A) and stone extraction (B).
Fig. 4
Fig. 4
Intraoperative picture showing the intracorporeal transversal enterotomy closure.
See this image and copyright information in PMC

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