Gallstone Ileus with Intraoperative Endoscopy: A Case Report

Abstract

A 68-year-old woman visited our hospital with complaints of abdominal pain and nausea. Abdominal computed tomography (CT) showed a cholecystoduodenal fistula and a dilated loop of the small intestine, with a calcified mass in the small intestine. Emergency surgery was performed under the diagnosis of gallstone ileus, and an impacted gallstone was extracted from the small intestine by enterotomy. Remaining gallstones were suspected from the CT findings. However, because of severe inflammation of the gallbladder and obesity, it was difficult to clearly visualize the duodenum and gallbladder. Therefore, we performed intraoperative endoscopy, which enabled us to confirm and extract all the gallstones from the gallbladder, stomach, duodenum and small intestine. No recurrence has been seen as of two years after the surgery. There have been some previous reports of gallstone ileus during the early postoperative period. Intraoperative endoscopy was effective for preventing recurrence of gallstone ileus.