Case of gallstone ileus and dislodged stent post endoscopic gallbladder drainage

Abstract

Figures

Gallstone ileus in patient post-endoscopic gallbladder drainage requiring emergency laparotomy.

Dislodged lumen apposing metallic stent and double pigtail set retrieved via colotomy at the hepatic flexure.

Full text

Endoscopic gallbladder drainage (EGBD) is a novel technique that allows biliary drainage by deploying a stent from the gallbladder to the gastrointestinal tract under endoscopic ultrasound guidance. It has become widely accepted for biliary drainage in non-surgical candidates with acute cholecystitis 1 . While this technique is reported to have a high success rate and low adverse events profile 2 , it is not without its risk. This is the first report of a case of gallstone ileus and dislodged stent in a patient post-EGBD necessitating major laparotomy.

A 78-year-old man was first presented to us for acute calculous cholecystitis. He had past medical history of diabetes mellitus, hyperlipidaemia and ST-elevation myocardial infarction and was wheelchair-bounded. EGBD ( Video 1 ) was performed, and the patient was subsequently discharged 6 days later. He refused interval cholecystectomy due to his premorbid status.

This video illustrates a case of endoscopic gallbladder drainage in a patient with cholecystitis and the rare complication of gallstone ileus and dislodged metallic stent necessitating laparotomy.Video 1

He was admitted to us again later for intestinal obstruction. Computed tomography (CT) of the abdomen and pelvis showed dilated small bowels with an impacted 4 cm gallstone at mid jejunum causing abrupt transition. The lumen apposing metallic stent and double pigtail were also dislodged to the hepatic flexure of the colon.

Emergency laparotomy was performed with the gallstone removed through enterotomy at jejunum ( Fig. 1 ). The lumen apposing metallic stent and double pigtail were also removed through colotomy at the hepatic flexure ( Fig. 2 ). Post-operatively, the patient recovered from prolonged ileus and hospital acquired pneumonia and was discharged on post-operative day 34.

Gallstone ileus in patient post-endoscopic gallbladder drainage requiring emergency laparotomy.

Dislodged lumen apposing metallic stent and double pigtail set retrieved via colotomy at the hepatic flexure.

This is the first report of gallstone ileus and dislodged stent in a patient post-EGBD necessitating major laparotomy. Although rare, it remains a potential complication of EGBD with the iatrogenic cholecystoduodenal fistula. This case highlights the importance of early recognition of such a potential complication for timely surgical intervention.

Endoscopy_UCTN_Code_CPL_1AK_2AD