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CASE REPORT
 
Endoscopic laser lithotripsy for gallstone large bowel obstruction
Moutaz Alkhusheh1, Alfredo Fausto Tonsi1, Stuart Reiss2, E RTC Owen3, Kalkata Reddy4
1Senior surgical registrar, Department of Surgery, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, United Kingdom.
2Surgical trainee, Department of Surgery, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, United Kingdom.
3Consultant general and colorectal surgery, Department of Surgery, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, United Kingdom.
4Associate specialist in surgery, Department of Surgery, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, United Kingdom.

doi:10.5348/ijcri-2011-04-28-CR-3

Address correspondence to:
Dr. Moutaz Alkhusheh
Department of Surgery
East Surrey Hospital
Canada Avenue
Redhill, Surrey, Redhill,
Surrey, RH1 5RH,
Phone: 004401737768511
Email: mbkhusheh@hotmail.com

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How to cite this article:
Alkhusheh M, Tonsi AF, Reiss S, Owen E RTC, Reddy K. Endoscopic laser lithotrepsy for gallstone large bowel obstruction. International Journal of Case Reports and Images 2011;2(4):11-14.


Abstract
Introduction: Colonic Gallstone ileus (CGI) is an uncommon mechanical bowel obstruction caused by intraluminal impaction of one or more gallstones. Gallstones enter the colon though a fistula between the gallbladder and the transverse colon wall.
Case Report: We report a case of an 83-year-old lady who presented with symptoms of large bowel obstruction. The Contrast Enhanced Computed Tomography (CECT) of the abdomen showed an obstructing gallstone in the sigmoid colon and extensive diverticulosis. At colonoscopy, a large gallstone was seen impacted in the sigmoid colon. Endoscopic laser lithotripsy under general anesthesia was successful in relieving the obstruction. This procedure avoided the unfit patient a major surgery.
Conclusion: Colonic gallstone ileus is a rare type of large bowel obstruction caused by gallstone impaction in patients with cholecysto-colonic fistula. We describe a case of CGI successfully treated with endoscopic laser lithotripsy. This therapeutic endoscopic approach of impacted colonic gallstone is effective and can be attempted in order to avoid surgery, especially in elderly patients, who are unfit for surgery.

Key Words: Endoscopic laser lithotripsy, Colonic gallstone ileus, Endoscopic laser lithotripsy, Contrast enhanced computed tomography

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Author Contributions:
Moutaz Alkhusheh - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Alfredo Fausto Tonsi - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Stuart Reiss - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Final approval of the version to be published
E RTC Owen - Substantial contributions to conception and design of data, Revising the data critically for important intellectual content, Final approval of the version to be published
Kalkata Reddy - Substantial contributions to conception and design, Analysis and interpretation of data, Revising the data critically for important intellectual content, Final approval of the version to be published
Guarantor of submission:
The corresponding author is the guarantor of submission.
Source of support:
None
Conflict of interest:
The corresponding author is the guarantor of submission.
Copyright:
© Moutaz Alkhusheh et. al. 2011; This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see copyright policy for more information.)