Abstract
Gallstone ileus is a rare mechanical bowel obstruction, and previously reported cases have been treated laparoscopically with good results. Although transvaginal hybrid NOTES without a minilaparotomy has been reported to decrease the incidence of surgical wound complications, to our knowledge, this procedure has not been used previously to treat gallstone ileus. We present a case of a 63-year-old woman who underwent transvaginal hybrid NOTES procedure for treatment of gallstone ileus. This case was admitted to our hospital following acute-onset abdominal pain and vomiting. We diagnosed gallstone ileus with cholecystoduodenal fistula by computed tomography and performed totally laparoscopic surgery using only three 5 mm abdominal ports with transvaginal specimen extraction and enterectomy. The patient's postoperative course was uneventful, and laparoscopic cholecystectomy and fistula repair were performed 8 months after the initial surgery. The patient experienced additional pain relief and good cosmetic outcomes. In conclusion, using transvaginal hybrid NOTES may become a future option to minimize the invasiveness of other laparoscopic procedures.
Highlights
Gallstone ileus is a rare bowel obstruction accounting for 1%–3% of all cases of mechanical obstruction of the small bowel [1]
Conventional laparoscopic surgery for gallstone ileus requires an abdominal minilaparotomy for gallstone extraction
We present a case of transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES) procedure for treatment of gallstone ileus followed by laparoscopic cholecystectomy and fistula repair, 8 months after the initial operation
Summary
Gallstone ileus is a rare bowel obstruction accounting for 1%–3% of all cases of mechanical obstruction of the small bowel [1]. Gallstone ileus is an abdominal emergency, usually treated surgically. Open enterolithotomy has been the surgery of choice, but many cases are operated laparoscopically with good results [2, 3]. Conventional laparoscopic surgery for gallstone ileus requires an abdominal minilaparotomy for gallstone extraction. Transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES), which does not involve a minilaparotomy, has been associated with decreased surgical wound complications [4, 5]. We present a case of transvaginal hybrid NOTES procedure for treatment of gallstone ileus followed by laparoscopic cholecystectomy and fistula repair, 8 months after the initial operation
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