Gallstone ileus: Endoscopic removal of a gallstone obstructing the lower ileum

2 citazioni su Scopus http://www.sciencedirect.com/science/article/pii/S1590865808004337 http://www.scopus.com/record/display.url?eid=2-s2.0-67349129737&origin=resultslist&sort=plf-f&src=s&st1=benassai&st2=g&sid=oNVoDQG_UHipYnJz9G131SP%3a210&sot=q&sdt=b&sl=30&s=TITLE-ABS-KEY-AUTH%28benassai+g%29&relpos=5&relpos=5&searchTerm=TITLE-ABS-KEY-AUTH(benassai g) An 81-year-old presented with a 5-day history of increasing abdominal pain, distension, and vomiting. Her bowels were not active for 2 days, but she was passing flatus. Laboratory examination showed a haemoglobin of 9.7 g/dL (≤14 g/dL), haematocrit of 29.7% (≥41%), leucocytes of 13.6/nl (≤10.0/nl), creatinine of 3.7 mg/dL (≤1.1 mg/dL). A plain abdominal X-ray showed small bowel distension; abdominal CT with contrast media showed a large gallstone in the lower ileum. Distended bowel loops were shown as a sign of a small intestinal ileus. Pneumobilia was not present (Fig. 1). Due to the weakened state of the patient and the concurrent diseases (coronary heart disease, congestive heart failure, renal insufficiency), an operation was considered unsafe and an endoscopic removal of the stone was tried. Colonoscopy revealed a large gallstone obstructing the distal ileum (about 10 cm above the ileo-cecal valve) The mucosa was diffusely edematous (Fig. 2). The stone was mobile and it was possible to grab the stone with a Roth net device (US Endoscopy, Mentor, OH, USA), to remove it from the site of impaction and finally retrieve the stone trough the anus. The stone measured 3.5 cm × 3.5 cm × 3 cm. The patient rapidly recovered and was discharged 5 days later. Gallstone ileus occurs almost exclusively in the elderly and accounts for 25% of mechanical small-bowel obstructions in patients over the age of 65, with a mortality of 15%. Early surgical intervention is the mainstay of treatment for gallstone ileus but has a mortality of 12–50%. Colonoscopic retrieval may be technically possible, carries small risks compared with surgery, and requires a shorter period of rehabilitation [1], [2] and [3].