Large Bowel Obstruction Due to a Big Gallstone Successfully Treated with Endoscopic Mechanical Lithotripsy.

Marco Balzarini,Calcedonio Calcara,Laura Broglia,Giovanni Comi

doi:10.1155/2015/798746

Abstract

Colonic gallstone ileus in an uncommon mechanical bowel obstruction caused by intraluminal impaction of one or more gallstones. The surgical management of gallstone ileus is complex and is potentially of high risk. There have been reports of gallstone extractions using various endoscopic modalities to relieve the obstruction. In this report we present the technique employed to successfully perform a mechanical lithotripsy and extraction of a large gallstone embedded in a sigmoid colon affected by diverticular stenosis. We passed through the stenosis with a 11.3 mm videoscope with 3.7 mm channel. A large lithotripsy extraction basket was used to catch and break up the stone and fragments were removed using the same basket. The patient was discharged asymptomatic three days after the procedure. Using appropriate devices mechanical lithotripsy is a safe and effective method to treat colonic obstruction and avoid surgery in the setting of gallstone ileus even in case of big stones.

Highlights

Despite gallstone ileus accounting for 25% of mechanical small bowel obstruction in patients over 65 years of age, colonic gallstone obstruction is a rare event and surgical intervention is usually required [1]
We present the case of an elderly woman with a large calcified stone impacted in a stricture of the sigmoid colon who was successfully treated with one session of endoscopic mechanical lithotripsy
Accessible impacted gallstones are amenable to less invasive alternative therapeutic options including intracorporal laser lithotripsy and endoscopic mechanical lithotripsy for fragmentation but usually it is not possible to use Dormia basket in case of big stones while intracorporal laser lithotripsy is not commonly available

Summary

Introduction

Despite gallstone ileus accounting for 25% of mechanical small bowel obstruction in patients over 65 years of age, colonic gallstone obstruction is a rare event and surgical intervention is usually required [1]. This has been shown to be successful, different endoscopic options to remove gallstone from the large bowel were attempted including extracorporeal lithotripsy, Dormia baskets, and polypectomy snares [2,3,4,5]. We present the case of an elderly woman with a large calcified stone impacted in a stricture of the sigmoid colon who was successfully treated with one session of endoscopic mechanical lithotripsy

Case Report

Discussion

Findings

Conflict of Interests