Cases and Techniques Library (CTL) E485 The patient was discharged after 15 days with complete resolution of the occlusive Effective endoscopic holmium laser lithotripsy symptoms, and her scheduled chole- in the treatment of a large impacted gallstone cystectomy was canceled. in the duodenum Endoscopy_UCTN_Code_CCL_1AZ_2AD Competing interests: None Fig. 1 Computed tomographic scan shows a large calcified Vincenzo Mirante, Helga Bertani, ring (stone) in the Giuseppe Grande, Mauro Manno, duodenum of an Angelo Caruso, Santi Mangiafico, 87-year-old woman Rita Conigliaro presenting with ab- U.O.C. Gastroenterology and Digestive dominal pain and vomiting of 3 days’ Endoscopy Unit, Nuovo Ospedale Civile duration. Sant'Agostino Estense, Modena, Italy References 1 Reisner RM, Cohen JR. Gallstone ileus: a re- view of 1001 reported cases. Am Surg 1994; 60: 441–446 2 Rodriguez H, Codina C, Girones V et al. Gall- stone ileus: results of analysis of a series of Gallstone ileus is caused by the passage To fragment the stone, we performed an- 40 patients. Gastroenterol Hepatol 2001; – of one or more large gallstones (at least other endoscopic procedure. A holmium 24: 489 494 3 Rigler LG, Borman CN, Noble JF. Gallstone ob- 2.5 cm in size) in the gastrointestinal tract laser (HLS30W Holmium:YAG 30W Laser; struction: pathogenesis and roentgen mani- through a bilioenteric fistula. It accounts Olympus America, Center Valley, Penn- festations. JAMA 1941; 117: 1753 –1759 for 1 % to 4% of all cases of mechanical sylvania, USA) was applied for a total of 4 Goldstein EB, Savel RH, Pachter HL et al. Suc- small-bowel obstruction [1,2]. The ob- approximately 200 minutes. This resulted cessful treatment of Bouveret syndrome structing gallstone is usually impacted in in fragmentation of the stone into small using holmium: YAG laser lithotripsy. Am Surg 2005; 71: 882–885 the terminal ileum, rarely the duodenum parts, which were removed with an ex- [1]. Computed tomography generally re- traction basket and a retrieval device veals mechanical bowel obstruction, (●" Video 1). Bibliography pneumobilia, and an ectopic stone in the DOI http://dx.doi.org/ 10.1055/s-0034-1393150 intestinal lumen (Rigler’s triad) [3]. Al- Endoscopy 2015; 47: E485 though surgery is considered the gold © Georg Thieme Verlag KG standard treatment, a less invasive endo- Video 1 Stuttgart · New York scopic approach is advisable in high risk ISSN 0013-726X patients [4]. An 87-year-old woman was admitted to Corresponding author the emergency department with abdomi- Vincenzo Mirante, MD ’ nal pain and vomiting of 3 days duration. Gastroenterology and Digestive Endoscopy Unit Computed tomography showed a large, Nuovo Ospedale Civile Sant’Agostino Estense calcified ring in the duodenum and aero- Via Pietro Giardini 1355 bilia (●" Fig.1). Upper gastrointestinal 41126 Modena endoscopy revealed a large obstructive Italy This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. Fax: +39-59-3961216 stone in the duodenal bulb that could not [email protected] be removed endoscopically, even after pyloric dilation. Because of the obstruc- Endoscopic holmium laser lithotripsy treat- tive symptoms, a gastrojejunal anastomo- ment of a large impacted gallstone in the sis was created, which partially relieved duodenum. the obstruction. Mirante Vincenzo et al. Endoscopic holmium laser lithotripsy of a large impacted gallstone… Endoscopy 2015; 47: E485.