Abstract
A 70-year-old woman who complained of nausea and vomiting lasting for two weeks was admitted to our hospital due to small bowel obstruction. Abdominal CT visualized calcification in the small bowel and gas in the gallbladder. The findings were also suggestive of adhesion in the gallbladder and duodenum. Therefore, gallstone ileus with a cholecystoduodenal fistula was diagnosed. Since the bowel obstruction did not resolve with conservative therapy, a two-stage laparoscopic surgery was performed. Initially, a single-incision laparoscopic surgery was carried out, and laparoscopy showed the site of small bowel obstruction and severe adhesion around the gallbladder. Therefore, enterolithotomy was performed using only the port incision site. On postoperative day 33, laparoscopic surgery consisting of cholecystectomy and closure of the cholecystoduodenal fistula was performed and the fistula on the duodenal side was treated with omental patch repair. Laparoscopic surgery has recently been recognized to be feasible for the treatment of gallstone ileus. Here, we describe the use of two-stage laparoscopic surgery for gallstone ileus with a cholecystoduodenal fistula, with a review of the literature.
