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A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy

A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy

Published on: September 13, 2022

Gallstone Ileus With Persistent Cholelithiasis and Choledocholithiasis.

Megan Ayres¹, Cecelia Kim¹, Trevy Ramos¹

¹Department of Trauma Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.

The American Surgeon

|June 6, 2023

Summary

Gallstone ileus, a rare surgical complication, can be effectively treated with a single-stage operation. This approach, involving enterolithotomy and gallbladder management, offers a successful outcome for stable patients.

Keywords:

acute care surgery gallstone ileus hepatobiliary liver

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Area of Science:

General Surgery
Gastroenterology
Surgical Case Reports

Background:

Gallstone ileus is an uncommon complication of cholelithiasis.
Optimal surgical management, single-stage versus two-stage operations, remains debated.
This report details a case of gallstone ileus managed with a single-stage procedure.

Observation:

A 73-year-old female presented with small bowel obstruction due to a gallstone.
The patient had concurrent cholelithiasis and a cholecystoduodenal fistula.
A single-stage surgery was performed, including enterolithotomy, cholecystectomy, fistula repair, and cholangioscopy.

Findings:

The patient recovered well following the single-stage surgery.
No recurrent symptoms were observed post-discharge.
The procedure successfully addressed both the bowel obstruction and the underlying biliary pathology.

Implications:

A single-stage operation is a viable and effective treatment for hemodynamically stable patients with gallstone ileus.
This approach can resolve gallstone ileus, cholelithiasis, and biliary fistulas concurrently.
Definitive single-stage management may be considered the standard of care in select gallstone ileus cases.