A Case Report on Gallstone Ileus Treated with the Endoscopy

Abstract

An 85-year-old female patient visited our emergency department with a history of lower abdominal pain and vomiting. Abdominal plain CT showed small bowel obstruction caused by a gallstone measuring 3 cm in size in the terminal ileum, gas in the gallbladder and adhesion in the gallbladder and duodenum. Thus, gallstone ileus with a cholecystoduodenal fistula was diagnosed. The gallstone was removed by the lower gastrointestinal endoscopy. Because of the high-risk status of the patient surgery, such as cholecystectomy or resection of the cholecystoduodenal fistula was not performed. Upper gastrointestinal endoscopy and radiography revealed the cholecystoduodenal fistula in the anterior wall of the duodenal bulb. Upper gastrointestinal radiography showed that the cholecystoduodenal fistula had been closed spontaneously without any complications on the 13th hospital day. Endoscopic removal of gallstone causing ileus is safe and effective as a less invasive alternative compared with surgery, although it requires condition that endoscope could reach the gallstone. The treatment method for the cholecystoduodenal fistula should be selected keeping in mind that conservative treatment, without surgery, may be effective.