Successful endoscopic mechanical lithotripsy for post-ERCP gallstone ileus: a case report

Area of Science:

• Gastroenterology
• Hepatobiliary Medicine

Background:

• Gallstone ileus is a rare, severe complication of gallstone disease, often requiring surgical intervention.
• Minimally invasive, nonsurgical treatments are crucial for high-risk patients.

Observation:

• A 63-year-old female presented with symptoms of a large common bile duct stone (3.9 cm).
• Initial endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and stenting was performed due to stone size.
• Post-ERCP, the patient developed gallstone ileus, confirmed by imaging and elevated inflammatory markers.

Findings:

• Endoscopic stone extraction and fragmentation were successfully employed to relieve the intestinal obstruction.
• Biliary and pancreatic stents were placed to manage the condition.
• The patient recovered well with no recurrence at 2-month follow-up.

Implications:

• This case highlights the efficacy of endoscopic stone extraction and fragmentation for managing post-ERCP gallstone ileus.
• Non-surgical endoscopic management offers a viable alternative to surgery in select patients.
• Successful treatment demonstrates the potential for minimally invasive techniques in complex hepatobiliary complications.