Successful gallstone ileus treatment by endoscopy.

Area of Science:

• Gastroenterology
• Surgical Pathology

Background:

• Gallstone ileus is a rare complication of cholelithiasis.
• Colonic impaction of gallstones is exceptionally uncommon, particularly in the sigmoid colon.

Observation:

• A 73-year-old woman presented with acute constipation, abdominal pain, and vomiting.
• CT scan revealed sigmoid colon obstruction by a large gallstone (43x20mm) and a cholecystocolic fistula with pneumobilia.

Findings:

• Urgent colonoscopy successfully extracted the impacted gallstone using a Roth Net, resolving the obstruction.
• The patient underwent surgical repair of the fistula and cholecystectomy.
• Post-operative complications included ascending colon perforation and necrotizing fasciitis, leading to abdominal septic shock and death.

Implications:

• This case highlights the critical importance of considering unusual presentations of gallstone disease.
• Prompt endoscopic intervention can resolve colonic obstruction, but surgical management carries significant risks.
• Complex cases necessitate multidisciplinary care to optimize patient outcomes in rare gastrointestinal emergencies.