A Novel Approach to the Laparoscopic Management of Gallstone Ileus

Deepika Koganti, Stephen Doane, Francesco Palazzo, Michael Pucci. Thomas Jefferson University

Gallstone ileus is a rare cause of bowel obstruction but is associated with a high mortality.  Surgical management involves enterotomy with removal of the obstructing gallstone.  A cholecystectomy and takedown of cholecystoenteric fistula may or may not be performed at that time.  We present a novel management option for gallstone ileus: laparoscopic enterotomy with cholecystotomy and stone extraction.  With this approach, the patient receives the benefits of minimally invasive surgery.  Moreover, the risks of bile duct injury and a high output enteric fistula are minimized by avoiding cholecystectomy.  Finally, by extracting remaining gallstones through the cholecystotomy, the risk of recurrent gallstone ileus is decreased. 

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