Electrohydraulic Lithotripsy for Treatment of Gallstone Ileus Complicated by an Ileocolonic Anastomotic Stricture
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The management of gallstone ileus has primarily involved surgical intervention by enterolithotomy with or without bowel resection. Given that gallstone ileus is most common in elderly patients with comorbidities, the mortality and morbidity associated with surgical intervention are significant. We report a case of using electrohydraulic lithotripsy (EHL) to treat gallstone ileus in a patient with ileocolonic anastomotic stenosis. A 73-year-old male with a history of cirrhosis, Crohn's disease, prior small bowel resection and ileocolonic anastomosis presented with lower abdominal pain, nausea and vomiting. He underwent colonoscopy, which demonstrated an impacted 3 cm by 2 cm mixed pigment gallstone at the site of his prior ileocolonic anastomosis. This anastomosis appeared to have strictured. Previous attempts using a Roth net were unsuccessful in retrieving the stone. The patient was referred to an academic tertiary care center for further management of his gallstone ileus. He underwent a colonoscopy, where the gallstone was identified at the stenotic ileocolonic anastomosis. The anastomosis was dilated under endoscopic and fluoroscopic guidance to 20mm. Initial attempts to retrieve the stone with a Roth net were unsuccessful in pulling the stone through the anastomosis. The decision was made to perform electrohydraulic lithotripsy. The EHL generator and at a power level of 100 and shock frequency of 15 shocks/second was utilized. The lumen was perfused with saline to provide the fluid medium at the stone-probe interface for EHL. Shock waves were delivered which led to effective fragmentation of the stone. The fragmented stones were cleared from the small bowel entirely through using a Roth net basket. On 8 weeks follow-up, patient continues to remain asymptomatic. Technique Highlights: EHL in this instance was effective in fragmenting a large gallstone. In using this technique, complete immersion with saline should be used as the medium in the lumen of the bowel. Also care must be made to ensure constant visualization of contact of the EHL probe and the stone or fragment being targeted. Our case highlights the potential role of EHL to treat complicated cases of gallstone ileus in patients who are poor surgical candidates for enterolithotomy.Figure: Gallstone in Small bowel.Figure: Fragmented stone after EHL.Keywords:
Gallstone Ileus
Ileus
Objective To study imaging findings of gallstone ileus and to discuss the value on diagnosis. Methods The image findings of 15 patients with gallstone ileus confirmed by clinical information were reviewed retrospectively.Results Signs of ileus, ectopic gallstone, and penumobilia were seen in all cases. The distorted gallbladder was seen in 14 cases except one case with the gallbladder resection. Signs of biliary enteric fistula were seen in 4 cases, and peritoneal fluid was seen in 2 cases. Abdominal plain films were performed in 5 cases in the same time and signs of penumobilia were seen in 1 case. Signs of ileus were seen in 3 cases. Gastroenterography study was performed in 2 cases and signs of biliary enteric fistula were seen in 2 cases, and filling defect of the bowel in 1 case. Abdominal US was performed in 7 cases. Gallbladder abnormalities were seen in 7 cases, and penumobilia in 3 cases. Conclusion Primary result revealed that the CT appearance of gallstone ileus was particularly striking. CT is the best valuable tool for the diagnosis of gallstone ileus, and X-ray plain film and sonography examination are shown to be very good screening examinations.
Gallstone Ileus
Ileus
Biliary fistula
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Gallstone Ileus
Ileus
Large bowel obstruction
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Gallstone ileus as a cause of distal jejunal obstruction is rare. Herein we present a case of gallstone ileus without any previous biliary symptoms and with Rigler’s triad on radiological investigation. As the signs and symptoms of gallstone ileus is nonspecific high index of suspicion is necessary to make a diagnosis of gallstone ileus. One staged cholecystectomy, fistula repair and enterolithotomy was done and patient recovered uneventfully.
Gallstone Ileus
Ileus
Biliary fistula
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This is a report on nine cases presenting biliary ileus. All patients undergo operative management. Two female patients present Bouveret's syndrome. The inference is reached that gallstone induced intestinal obstruction is characterized by atypical clinical patterns, conditioning in turn the diagnostic difficulties encountered, and the necessity to undertake operative treatment against the background of advanced ileus. The latter is one of the rarest forms of intestinal obstruction. Biliary ileus treatment consists in the removal of small intestinal impatency. The concretion is pushed in oral direction, and its evacuation is successfully accomplished by enterotomy, duodenotomy or gastrotomy. Two fatal outcomes due to severe advanced form of ileus are reported.
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Abstract This case report illustrates the difficulties in making the clinical diagnosis of gallstone ileus. In addition to an unusual clinical picture, the changes normally expected on abdominal X-ray in gallstone ileus were subtle and missed in our patient. The diagnosis was made using abdominal computerised tomography (CT). We recommend the early use of abdominal CT scanning in the investigation of clinical bowel obstruction, especially in the elderly, where gallstone ileus is a more common condition.
Gallstone Ileus
Ileus
Abdominal computed tomography
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Gallstones are common, but rarely cause ileus. This case report illustrates the clinical course of a patient who developed gallstone ileus without any previously identified gallstone symptoms.
Gallstone Ileus
Ileus
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Gallstone ileus is a rare cause of small bowel obstruction which usually presents in elderly female patients and which has been associated with high morbidity and mortality rates. We present the case of a 63-year-old man who presented at our institution with symptoms of bowel obstruction. Abdominal X-ray and exploratory laparotomy revealed a large gallstone in the terminal ileus.
Gallstone Ileus
Ileus
Exploratory laparotomy
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Gallstone ileus is a well-known cause of small bowel obstruction in the radiological literature. In the experience of these authors, gallstone ileus occurs more often in quiz cases for registrars than in the everyday casework of a radiologist. The here presented case of a gallstone ileus provides a good opportunity to summarize cause, clinical presentation, radiological findings, and treatment options for both those studying for the specialist examinations and those whose specialist examinations are long past.
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Gallstone ileus is a mechanical obstruction of the intestinal tract caused by gallstones. Usually, the responsible stone is solitary and large, 2 to 5 cm in diameter, and enters the bowel through a cholecystoduodenal fistula. Gallstone ileus is not a common occurrence. This condition can be difficult to diagnose, causing a delay in surgical treatment. Because of this delay, the mortality rate is high, 15% to 20%. When the diagnosis of gallstone ileus is made preoperatively, it is usually done radiographically. In this case, the diagnosis was made based on the ultrasound findings.
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Ileus
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Gallstone ileus is a rare disease, which is responsible for about 1%-4% of all cases of mechanical obstruction. The findings of gallstone ileus on computed tomography (CT) are pathognomonic. The morbidity and mortality rate remain very high, mainly because of delayed diagnosis. We report a case of gallstone ileus which caused intestinal obstruction which was diagnosed on a contrast-enhanced CT scan of the abdomen.
Gallstone Ileus
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Ileus
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