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[Extracorporeal shockwave lithotripsy in gallstone perforation]
1Medizinische Klinik A, Klinikum Barmen, Wuppertal.
Deutsche Medizinische Wochenschrift (1946)
|April 3, 1992
Summary
A large gallstone perforated into the duodenum, causing obstruction. Extracorporeal shockwave lithotripsy successfully broke up the stone, resolving the patient's symptoms and enabling oral intake.
Area of Science:
- Gastroenterology
- Endoscopy
- Gastrointestinal Surgery
Background:
- A 78-year-old male patient presented with hematemesis and worsening duodenal obstruction.
- Comorbidities included rheumatoid arthritis, arteriosclerosis, and severe cardiac arrhythmias (Lown grade IVb).
Observation:
- Initial gastroscopy revealed a bleeding ulcer and mucosal protrusion in the deformed duodenal bulb.
- A subsequent gastroscopy identified a 4 cm gallstone perforated into the duodenal bulb, causing progressive obstruction and vomiting.
- Endoscopic removal of the gallstone was not feasible.
Findings:
- Ultrasound-guided extracorporeal shockwave lithotripsy (ESWL) was performed in three sessions.
- ESWL successfully fragmented the gallstone without complications.
- Larger fragments were removed endoscopically, and smaller fragments passed spontaneously.
- Post-treatment ultrasonography confirmed a stone-free gallbladder and a cholecystoduodenal fistula.
Implications:
- ESWL offers a non-surgical option for managing large gallstones causing duodenal obstruction, particularly in high-risk patients.
- Successful management led to the resolution of symptoms, enabling oral feeding.
- This case highlights the successful application of ESWL in a complex clinical scenario involving a cholecystoduodenal fistula.