Laser lithotripsy as a solution of an obturating biliary stone in the colon
Vilma Zarembová1, Ivo Horný1
1 Interní oddělení, gastroenterologie, Nemocnice Strakonice, a. s.
This case report describes the course of treatment of complicated gallstones in a polymorbid patient, focusing on the use of laser lithotripsy to treat an obturating biliary stone in the sigmoid. Enterobiliary fistulas with large intestinal lithiasis account for 1–4% of complications of cholecystolithiasis. This condition may present with an acute mechanical ileus, but more often with non-specific bowel problems. Male patient, 87-year-old, was hospitalized repeatedly within 6 months for acute cholangoitis, cholecystitis, and a liver abscess with enterobiliary fistula. Nine years earlier, he had undergone surgery for a colorectal carcinoma. A coloscopic examination following cholecystectomy and patient stabilization showed a 25-mm biliary stone over the stenosis of the rectosigmoid anastomosis resulting from colorectal carcinoma surgery. Because of the risk of future development of biliary ileus, it was decided to crush the stone and extract its residue. Although mechanical lithotripsy was the first choice of treatment, it was repeatedly unsuccessful in this patient. Laser lithotripsy was chosen as next treatment approach, as it has been shown to be safer in selected patients with obturating intestinal biliary stone, especially those with polymorbid conditions. Moreover, this method is less burdensome to patients than surgery and thus therefore less expensive.
Keywordslaserová litotripse, cholecystolitiáza, gallstone ileus, colonoscopy
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