Mechanical intestinal obstructions caused by gallstones occur in approximately 1% to 2% of cases. In most of the patients, the obstruction occurs at the ileocecal valve. However, gallstones may cause obstruction anywhere along the gastrointestinal tract from the stomach to the sigmoid colon. Laparoscopically assisted enterolithotomy can be used as a treatment method. This report describes a case in which a gallstone blockage caused a mechanical obstruction in an atypical location, which was successfully treated with a laparoscopically assisted approach.

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We report our experience with self-expandable nitinol coil stents (InStent, Inc.) (range 0.5-20).Results: Using EBS alone, the bile duct was cleared in 70 patients (76%). Mechanical lithotripsy was used to remove large stones (15-20 mm) in 13 (15%). Of the 20 EBS "failures" (24%) papillotomy was required to clear the duct in 7 (9%). A pigtail stent was inserted in 13 (15%) to maintain biliary drainage a) as a temporary measure because of doubt about residual stones >15 mm (n = 7, 9%), or b) as a definitive measure in elderly high risk patients with multiple stones >15 mm (n = 6, 6.5%). ERCP was repeated in 14 (16%) for stent removal ± replacement or repeat EBS-duct clearance (n = 4). There was no papillary haemorrhage, while uncomplicated pancreatitis was observed in 4 patients (5%).Conclusion: EBS is a safe and effective sphincter preservation technique for the management of BD stones up to 20 mm in size, which significantly reduces the need for papillotomy.