Abstract
We report a case requiring laparoscopic surgical treatment of a gallstone ileus. An 83-year-old man developed vomiting and abdominal pain with acute renal insufficiency. Abdominal CT scan showed a small bowel obstruction caused by a 2-cm gallstone located in the terminal portion of the ileum ; pneumobilia was also noted. Preoperatively an Ileus tube was used to decompress the patient's distension. Laparoscopy revealed the site of the ileal obstruction ; severe adhesions around the gallbladder were also found. Laparoscopic enterolithotomy was performed with partial resection of the ileum. No additional procedure such as cholecystectomy or repair of the cholecystoduodenal fistula, was performed. It is controversial whether a one or a two-stage procedure is the optimal surgical treatment of gallstone ileus. It is important that the safest and the least invasive surgical approach be selected for patients with a gallstone ileus based on an appropriate evaluation of the patient's overall medical condition and their biliary tract disease.
