Short abstract
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BRIEF EXPLANATION
A 79‐year‐old man with repeated vomiting for the past month and abdominal distention was admitted to our hospital. Two gallstones, each 4 × 3 cm, had been detected 1 month prior (Video S1). A computed tomography examination revealed a stone impacted in the flexion of the terminal ileum, which completely obstructed the lumen and caused ileus. Immediate resolution of the ileus was obtained by transnasal ileus tube placement, while gallstone crushing was planned for the following day. For treating ileum obstruction by a gallstone, crushing is often difficult to perform because an endoscope has limited reach and poor operability. For the present patient, electrohydraulic lithotripsy (EHL) using a mother–baby system was employed. First, a colonoscope (CF‐HQ290ZI; Olympus, Tokyo, Japan) was inserted into the terminal ileum as the mother scope, then a longer scope (SpyScope DSII; Boston Scientific, Marlborough, MA, USA) was used as the baby scope. The findings obtained revealed a stone trapped in the terminal ileum flexure (Fig. 1), which was successfully crushed by EHL and completely removed. The following day, another gallstone impacted in the cholecystoduodenal fistula was also crushed using EHL.
Figure 1.
Endoscopy findings. (a) View from the mother scope. A gallstone impacting the terminal ileum can be seen (yellow arrow), as well as the baby scope close to the gallstone (red arrow). An ileus tube placed the day before can also be seen (green arrow). (b) View from the baby scope showing gallstone in the terminal ileum (yellow arrow).
The usefulness of endoscopic treatment with an EHL procedure has been reported for cases affected by obstruction of the duodenum or colon. 1 , 2 While the most common intestinal obstruction site is the terminal ileum, endoscopic treatment can be difficult because of the location far beyond the colonoscopic operability area. 3 Recently, successful treatment of such cases using balloon enteroscopy‐assisted EHL has been reported. 4 , 5 For the present patient, a mother–baby system was employed, which made it possible to crush a stone located far beyond the area covered by the mother scope and also provided accurate aiming because the target was near. This method was also found useful for the treatment of a gallstone impacted in the ileum of the patient.
Authors declare no conflict of interest for this article.
Supporting information
Video S1 A gallstone impacted in the terminal ileum was crushed using electrohydraulic lithotripsy with a mother–baby system.
REFERENCES
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Associated Data
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Supplementary Materials
Video S1 A gallstone impacted in the terminal ileum was crushed using electrohydraulic lithotripsy with a mother–baby system.