Intermittent gallstone ileus following endoscopic biliary sphincterotomy. A case report

Area of Science:

• Gastroenterology
• Surgical Gastroenterology

Background:

• Choledocholithiasis, the presence of gallstones in the common bile duct, can necessitate interventions like endoscopic sphincterotomy and lithotripsy.
• Complications following these procedures require careful diagnosis and management.

Observation:

• A 72-year-old woman experienced recurrent colicky abdominal pain post-endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and lithotripsy for common bile duct stones.
• Clinical presentation suggested a small bowel obstruction.

Findings:

• A large gallstone, remaining in the common bile duct after the procedure, was identified as the cause of the obstruction.
• The intermittent nature of the pain was attributed to the gallstone's movement (pendulation) between two areas of stenosis in the small bowel.
• These stenoses were a consequence of chronic radiation enteritis.

Implications:

• This case highlights a rare complication of gallstone disease and ERCP, emphasizing the importance of complete stone clearance.
• Understanding the role of pre-existing bowel strictures in the pathogenesis of intermittent gallstone ileus is crucial for diagnosis.
• Management strategies should consider the underlying causes of bowel stenosis when evaluating such presentations.