Totally laparoscopic resolution of gallstone ileus: A case report. (January 2022)

• Record Type: Journal Article
• Authors: Dreifuss, Nicolás H.; Schlottmann, Francisco; Cubisino, Antonio; Mangano, Alberto; Baz, Carolina; Masrur, Mario A.
• Is Part Of: International journal of surgery case reports. Volume 90(2022)
• Publication Date: 2022-01
• Subjects: Gallstone ileus -- Intestinal obstruction -- Laparoscopic surgery -- Enterolithotomy -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.106682
• Languages: English
• ISSNs: 2210-2612

Abstract

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. Highlights: Gallstone ileus is an uncommon complication of long-term cholelithiasis. CT scan is the best imaging modality for diagnosis and preoperative planning. Laparoscopic enterolithotomy is safe and results in low postoperative morbidity.