Gallstone ileus developing two months after endoscopic papillary large balloon dilatation: a case report

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Biliary Tract Diseases

Background:

• Gallstone ileus is a rare cause of bowel obstruction.
• Transpapillary migration of gallstones post-endoscopic retrograde cholangiopancreatography is uncommon.
• Gallstone ileus following endoscopic papillary large balloon dilatation is exceptionally rare.

Purpose of the Study:

• To report a rare case of gallstone ileus after endoscopic papillary large balloon dilatation.
• To emphasize the potential complications of difficult common bile duct stone extraction.

Main Methods:

• A case presentation of an 89-year-old female with acute cholangitis and choledocholithiasis.
• Endoscopic papillary large balloon dilatation was performed, but stone extraction was unsuccessful.
• The patient later developed gallstone ileus, managed initially with endoscopy and subsequently with surgery.

Main Results:

• The patient experienced gallstone ileus two months after the initial endoscopic procedure.
• Surgical fragmentation and distal pushing of the impacted stone were successful without enterotomy.
• The patient was discharged eight days post-surgery.

Conclusions:

• This is one of the few reported cases of gallstone ileus post-endoscopic papillary large balloon dilatation.
• Difficult common bile duct stone extraction requires consideration of alternative strategies to mitigate the risk of delayed spontaneous passage and gallstone ileus.