Totally laparoscopic management of gallstone ileus

Gallstone ileus is an uncommon disease of elderly patients who present with bowel obstruction. Mortality and severe complications are common, even in modern series, due to the comorbidities in the affected patient population. A number of less invasive ways to treat this disease are described. We report on a case where enterolithotomy was performed laparoscopically. The patient is a 60-year-old diabetic woman who presented with a bowel obstruction and pneumobilia on abdominal radiographs. She underwent exploratory laparoscopy using three reusable ports, an enterolithotomy, and her remaining bowel was examined. The benefits to a minimal access approach to this rare disorder are discussed. The ability to suture laparoscopically is emphasized.