Laparoscope-guided enterolithotomy for gallstone ileus

Two women, both aged 76 years, with several days of clinical symptoms of mechanical intestinal obstruction were diagnosed laparoscopically and found to have gallstone ileus. In one patient, pneumobilia was demonstrated preoperatively on plain abdominal radiography. Neither patient had had previous abdominal surgery. After searching through the small intestine laparoscopically, the stones were found. The site of obstruction was in both cases the ileum. The nondistended small intestine was visualized in the videoendoscope and lifted toward the anterior wall. Through very small lower midline and right lower quadrant muscle-splitting incisions, respectively, the ileum, including the gallstone, was brought out extracorporally, and the stone was removed by a simple enterolithotomy. Both patients recovered rapidly and returned to their homes on the fourth and fifth postoperative days, respectively. One patient returned after 3 weeks and was successfully treated for a wound infection. Four months after surgery, neither patient had any abdominal complaints. Laparoscopic diagnosis, and if possible treatment for mechanical intestinal obstruction, especially in elderly nonoperated patients, is suggested to minimize operative trauma, facilitate postoperative mobilization and hopefully reduce the high operative morbidity and mortality in this group of patients.