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Single-incision laparoscopic surgery for gallstone ileus: An alternative surgical procedure
Yusuke Watanabe1, Junkichi Takemoto2, Eiji Miyatake2
1Department of Emergency Medicine, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan.
Introduction:
Gallstone ileus (GI) results from the passage of a stone through a cholecystoenteric fistula, subsequently causing a bowel obstruction. The ideal treatment procedure for GI remains controversial.
Presentation Of Case:
A 63-year-old female was admitted to our hospital following persistent nausea and vomiting for 7 days. Computed tomography revealed a partially calcified 4-cm circular object in the jejunum, and the proximal intestine was dilated, with concomitant pneumobilia. Based on the preoperative diagnosis of GI, enterotomy with stone extraction by single-incision laparoscopic surgery (SILS) was performed. The patient's postoperative course was uneventful, and the cholecystoduodenal fistula closed spontaneously 4 months after the surgery.
Discussion:
Recent studies have reported that enterotomy with stone extraction alone is associated with better outcomes than with more invasive techniques. This case also suggests that enterotomy with stone extraction alone and careful postoperative follow-up is feasible for the management of GI. Although the use of laparoscopy in the management of GI has been described previously, laparoscopic surgery has not been widely performed, and SILS is not generally performed. When only this less demanding procedure is required, laparoscopic surgery, including SILS, can be a viable option.
Conclusion:
SILS can be an alternative surgical procedure for the management of GI.
