Large bowel obstruction due to gallstones: an endoscopic problem?

Area of Science:

• Gastroenterology
• Surgical Innovation

Background:

• Gallstone impaction in the large bowel is a rare cause of intestinal obstruction.
• Cholecystoenteric fistula formation can lead to gallstone ileus.

Observation:

• A 73-year-old male presented with symptoms of large bowel obstruction.
• CT scan revealed a 4cm impacted gallstone causing rectosigmoid obstruction and pneumobilia.
• Initial endoscopic attempts to remove the stone failed.

Findings:

• A novel endoscopic mechanical lithotripter was used to fragment the large gallstone.
• The fractured gallstone fragments were passed spontaneously within 24 hours.
• The patient recovered fully without surgical intervention.

Implications:

• Endoscopic mechanical lithotripsy offers a minimally invasive treatment option for gallstone-induced bowel obstruction.
• This approach can help patients avoid the risks associated with surgical management.
• Highlights the importance of considering gallstone disease in the differential diagnosis of bowel obstruction.