GALLSTONE ILEUS MANAGED BY LAPAROSCOPIC ENTEROLITHOTOMY: A CASE REPORT ors.rzh@gmail.com

 

GALLSTONE ILEUS MANAGED BY LAPAROSCOPIC ENTEROLITHOTOMY: A CASE REPORT

2

Mexico

Poster Exhibition only

Gallstone ileus is an uncommon cause of mechanical small bowel obstruction, occurring when a gallstone migrates through a bilioenteric fistula, most commonly cholecystoduodenal. Although rare, it is more prevalent in elderly or comorbid patients. Diagnosis relies on clinical suspicion and characteristic radiologic findings. This report presents a case managed successfully with laparoscopic enterolithotomy, highlighting diagnostic imaging and operative strategy.

A 54-year-old woman with longstanding cholelithiasis presented with colicky abdominal pain, bilious vomiting, and progressive abdominal distension over 48 hours. Examination showed diffuse tenderness without peritoneal signs. Laboratory testing revealed leukocytosis with normal liver function. Contrast-enhanced abdominal CT demonstrated pneumobilia, proximal bowel dilation, and a radiopaque gallstone impacted in the distal ileum. Laparoscopy identified a 3-cm pigment gallstone causing obstruction. A controlled enterotomy was performed, allowing stone extraction and transverse laparoscopic hand-sewn closure.

Laparoscopic enterolithotomy was completed without conversion. Cholecystectomy or fistula repair was deferred due to the patient’s stable condition and absence of recurrent biliary symptoms. The postoperative course was favorable, with bowel function recovery on postoperative day 3 and discharge on day 6. Follow-up confirmed complete symptom resolution.

Laparoscopic enterolithotomy is a safe and effective therapeutic option for gallstone ileus in selected patients. CT imaging is essential for diagnosis and surgical planning. This case underscores the value of correlating radiologic and minimally invasive operative findings to optimize management and outcomes.