Laparoscopic Gallstone Ileus Treatment

We present the case of a 78-year-old female with a complex medical history, including Diabetes, Hypertension, Hyperlipidemia, and severe Asthma. She also suffers from Atrial Fibrillation, managed with Eliquis. For over 20 years, she has lived with known gallstones - a silent condition that was about to take a critical turn."Her surgical journey intensified in 2022 with her first hospitalization for acute cholecystitis. In March 2023, due to her high-risk comorbidities, she was managed conservatively with a percutaneous cholecystostomy drain rather than surgery. Although the drain was eventually removed a year ago, it left behind a persistent cholecystocutaneous fistula."

"Just days before a scheduled elective cholecystectomy, the patient presented to the Emergency Room with acute right upper quadrant pain. Clinical examination revealed a positive Murphy’s sign and elevated inflammatory markers. Initial imaging showed a contracted gallbladder containing large stones, with a borderline wide common bile duct. While hospitalized for conservative management, her condition suddenly deteriorated. She became hemodynamically unstable, with tachycardia reaching 150 beats per minute and blood pressure dropping to 85/60 mmHg. Her abdomen became increasingly distended and tender. An urgent CT scan was performed, revealing the definitive diagnosis: Gallstone Ileus."

The surgical intervention.

Exploratory laparoscopy. The patient was rushed for an emergency exploratory laparoscopy. Upon scanning the small bowel, the transition point was identified. We performed an Enterolithotomy, carefully extracting a large, obstructing gallstone. The enterotomy was then closed laterally using a 3-0 absorbable barbed suture, restoring bowel continuity."