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Case Reports
. 2024 Nov 20;16(11):e74123.
doi: 10.7759/cureus.74123. eCollection 2024 Nov.

Laparoscopic-Assisted Enterolithotomy for Recurrent Gallstone Ileus: A Case Report

Kevin Vallejo  1 , Claudia Morales  1 , Alexa Denton  1 , Deep Vakil  2 , Lucia Castro Hernandez  2 , Charles Vallejo  3 , Fazaldin Moghul  4 , Christopher Seaver  4
Affiliations
Case Reports

Laparoscopic-Assisted Enterolithotomy for Recurrent Gallstone Ileus: A Case Report

Kevin Vallejo et al. Cureus. .

Abstract

Gallstone ileus is the mechanical obstruction of the bowel due to gallstone impaction. It forms when a fistula is created between the gallbladder and the gastrointestinal tract, which can result in small bowel obstruction. Its surgical management ranges from enterolithotomy, cholecystectomy, and fistula closure performed together (one-stage) or performed separately (two-stage), while some patients undergo simple enterolithotomy. Emergency surgery with open enterolithotomy, with or without biliary tract surgery, has been replaced by laparoscopic-assisted enterolithotomy as a safer and more rapid procedure. This report is of a 68-year-old woman treated with laparoscopic-assisted enterolithotomy for gallstone ileus which recurred. A 68-year-old woman with type 2 diabetes mellitus, hypertension, breast cancer, and end-stage renal disease on hemodialysis presented with a gallstone ileus and was surgically managed with successful laparoscopic-assisted enterolithotomy. Seven days after the initial surgery, she again presented with gallstone ileus requiring reoperation. A repeat laparoscopic-assisted enterolithotomy was performed with no complications and full resolution of her symptoms. Operative management of gallstone ileus and subsequent recurrence continues to be highly debated. With no randomized studies and limited data, there is no current gold standard surgical procedure for either setting. Simple laparoscopic-assisted enterolithotomy is the favored surgical technique as it is associated with decreased morbidity, mortality, operative time, and complications. This report demonstrates that a CT scan is crucial in differentiating recurrent gallstone ileus from postoperative ileus, with a repeat laparoscopic-assisted enterolithotomy providing a safe and effective treatment option. Moreover, patient follow up is essential for monitoring symptom resolution.

Keywords: case report; entero-biliary fistulae; gallstone ileus; gallstones complication; gastrointestinal ileus; gastrointestinal obstruction; laparoscopic-assisted enterolithotomy.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT demonstrating a stone in the small bowel (circled in red)
Figure 2
Figure 2. CT demonstrating cholecystoenteric fistula with a remaining stone in the gallbladder (circled in red)
Figure 3
Figure 3. Intraoperative picture taken with Optiview demonstrating the gallstone impacted in the jejunum (red arrow)
Figure 4
Figure 4. CT demonstrating an intraluminal gallstone in the distal ileum (circled in red) and a cholecystoenteric fistula (red arrow) with no remaining stones in the gallbladder
Figure 5
Figure 5. Intraoperative picture demonstrating impacted stone in the ileum (red arrow)
Figure 6
Figure 6. A 2.5 cm extracted gallstone and the small bowel with enterotomy
See this image and copyright information in PMC

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References

    1. Gallstone ileus, clinical presentation, diagnostic and treatment approach. Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL. World J Gastrointest Surg. 2016;8:65–76. - PMC - PubMed
    1. Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Abou-Saif A, Al-Kawas FH. https://pubmed.ncbi.nlm.nih.gov/11866258/ Am J Gastroenterol. 2002;97:249–254. - PubMed
    1. Comparison of surgical treatments of gallstone ileus: preliminary report. Doko M, Zovak M, Kopljar M, Glavan E, Ljubicic N, Hochstädter H. World J Surg. 2003;27:400–404. - PubMed
    1. Management and outcome of recurrent gallstone ileus: A systematic review. Mir SA, Hussain Z, Davey CA, Miller GV, Chintapatla S. World J Gastrointest Surg. 2015;7:152–159. - PMC - PubMed
    1. Clinical and radiological diagnosis of gallstone ileus: a mini review. Chang L, Chang M, Chang HM, Chang AI, Chang F. Emerg Radiol. 2018;25:189–196. - PMC - PubMed

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