Gallstone ileus after endoscopic sphincterotomy

An attack of gallstone ileus observed in a 60-year-old female patient is reported. In this patient who previously had been cholecystectomized, instant extraction of giant residual gallstones was unsuccessful despite a large endoscopic sphincterotomy. Three days later, she developed colicky abdominal pain and vomiting. At laparotomy nine days after the endoscopic procedure an impacted gallstone measuring 3.5 cm in diameter was removed from the the jejunum, some 50 cm below the ligament of Treitz. This observation demonstrates an unusual complication of endoscopic sphincterotomy and clearly outlines that very large stones can, after an initial delay, pass into the duodenum despite an apparently "unsuccessful" sphincterotomy.