Aaron L Sabbota, MD, PhD1, Huy Hoang, MD2, Amy Yetasook, MD1, Keith Boone, MD1, Pearl Ma1, Kelvin Higa, MD1. 1ALSA Medical Group, Fresno Heart and Surgical Hospital, 2UCSF Fresno Department of Surgery
Gallstone ileus is a rare cause of small bowel obstruction. This pathology is more common in elderly patients and is associated with considerable morbidity and mortality. We present a case of a 62 year-old morbidly obese female with a body mass index (BMI) of 45 presenting with abdominal pain, distension and bilious emesis seven months status post laparoscopic sleeve gastrectomy (LSG). BMI prior to LSG was 56. Patient was successfully treated with laparoscopic enterolithotomy and discharged on post-operative day 2. This video reviews the preoperative EGD prior to consideration for LSG. A small duodenal nodule was noted and biopsies showed normal duodenal mucosa. In retrospect, the intraoperative EGD performed at the time of laparoscopic sleeve gastrectomy showed signs of impending cholecystoduodenal fistula as there was significant omental adhesions to the right lobe of the liver obscuring visualization of the pylorus and a large mass noted in the proximal duodenum. CT scan obtained upon presentation of obstructive symptoms revealed a high-grade bowel obstruction with impacted stone in the mid-jejunum with concurrent pneumobilia. Lastly, the laparoscopic technique utilized for gallstone extraction and small bowel enterorrhaphy is displayed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 96029
Program Number: V321
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop