Large bowel obstruction due to gallstones: an endoscopic problem?

Abstract

SUMMARYA 73-year-old man was admitted with symptoms of large bowel obstruction. An emergency CT scan revealed pneumobilia and large bowel obstruction at the level of the rectosigmoid due to a 4×4 cm impacted gallstone. Flexible sigmoidoscopy confirmed the diagnosis but initial attempts to drag the stone into the rectum failed. An endoscopic mechanical lithotripter was employed to repeatedly fracture the gallstone into smaller fragments, which were passed spontaneously the next day. The patient made a complete recovery avoiding the potential dangers of surgery. This case report discusses cholecystoenteric fistula and a novel minimally invasive treatment for large bowel obstruction due to gallstones. BACKGROUND

A Rare complication of Cholelithiasis: Cholecystocolic Fistula – Case Report

“…CCF may also present with large bowel obstruction with stone obstructing in the sigmoid colon. 7,8 Had our patient presented as large bowel obstruction then the patient's prognosis would have been poor due to complications related to large bowel obstructions. These stones causing CCF tend to be >2.5 cm in diameter with smaller stones presumed to pass through to the colon.…”

“…Laparoscopic surgical treatment of CCFs has also been reported. 2,8 Large bowel obstruction may be treated with enterolithotomy, followed by primary repair or colostomy, or resection with anastomosis depending on the site of the colon. All the complicated CCF should be urgently intervened.…”

A single centre case series of gallstone sigmoid ileus management

“…Non-surgical management strategies such as lithotripsy and endoscopic snare/basket retrieval have yielded varying results. Several authors describe successful resolution of large bowel obstruction with lithotripsy [8] , [9] , [10] , [11] , [12] , [13] .…”

A rock in a hard place: a unique case of colonic gallstone ileus

“…Selected patients may undergo cholecystectomy and fistula repair at the time of enterolithotomy or later although the risks and benefits of this are debated with some authors advocating for no biliary procedures being undertaken 4,5 . Success with colonoscopic treatment in cases of colonic gallstone ileus has been reported 6 …”

“…4,5 Success with colonoscopic treatment in cases of colonic gallstone ileus has been reported. 6 This case is unique given the intersection of colonic gallstone ileus and near obstructing rectal cancer. It highlights that, while rare, there is a risk of colonic gallstone obstruction in patients with a known narrowing lesion and known cholelithiasis.…”