Colonic gallstone ileus treated with radiologically guided extracorporeal shock wave lithotripsy followed by endoscopic extraction

Abstract

Gallstone ileus is a rare cause of mechanical bowel obstruction due to the passage of a solitary large gallstone into the gastrointestinal tract through a cholecystoenteric fistula [1]. Early surgical intervention is the treatment of choice; however, the surgical mortality rate is high as most patients are elderly and many suffer from concomitant diseases [2]. Ultrasound-guided extracorporeal shock wave lithotripsy (ESWL) has been suggested as an effective, noninvasive therapeutic alternative to surgery. Cases of jejunal and gastric gallstone ileus treated with ESWL have already been described [3] [4] [5]. However, the use of ultrasound-guided ESWL is limited in the colon because the stones are often not radiopaque or only partially calcified, and are frequently covered by intestinal gas, which prevents clear localization of the gallstone. We describe a case of gallstone ileus of the colon that was successfully treated with radiologically guided ESWL that visualized the obstruction by focusing on a metallic clip that had been inserted during a previous rectosigmoidoscopy.