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Related Experiment Videos

Gallstone ileus after endoscopic sphincterotomy

F Halter, U Bangerter, J P Gigon

    Endoscopy
    |March 1, 1981
    PubMed
    Summary
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    Gallstone ileus can occur even after cholecystectomy. Giant residual gallstones may pass into the jejunum days after an endoscopic sphincterotomy, leading to complications.

    Area of Science:

    • Gastroenterology
    • Surgical Complications

    Background:

    • Gallstone ileus is a rare complication of gallstones, typically occurring in elderly patients.
    • Cholecystectomy is the standard treatment for symptomatic gallstones, but residual stones can remain.
    • Endoscopic sphincterotomy is used to remove bile duct stones but may not always be successful for large stones.

    Observation:

    • A 60-year-old female, previously cholecystectomized, presented with symptoms of gallstone ileus.
    • Initial endoscopic attempts to remove giant residual gallstones were unsuccessful.
    • The patient later developed abdominal pain and vomiting, indicating obstruction.

    Findings:

    • Laparotomy revealed a large impacted gallstone (3.5 cm) in the jejunum, 50 cm below the ligament of Treitz.
    • This occurred nine days after the endoscopic procedure, despite an initial 'unsuccessful' sphincterotomy.

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  • The case highlights that large stones can pass into the duodenum after a delay.

    • Implications:

    • This case demonstrates an unusual complication of endoscopic sphincterotomy.
    • It emphasizes the potential for delayed passage of very large gallstones into the gastrointestinal tract.
    • Clinicians should consider gallstone ileus in patients with prior biliary surgery presenting with obstructive symptoms, even after endoscopic procedures.