P1740 - Break It Up: Gallstone Sigmoid Obstruction Treated with Electrohydraulic Lithotripsy

Bhavi Trivedi, MD¹, Jesus Guzman, MD², Mohammad Bashashati, MD³, Brian Davis, MD¹, Vital Rangashamanna, MD⁴, Ihsan Al-Bayati, MD⁴, Sherif E. Elhanafi, MD^1
1Texas Tech University Health Sciences Center, El Paso, TX; ²Texas Tech Health Science Center, El Paso, TX; ³University of Texas Austin, Austin, TX; ⁴Texas Tech, El Paso, TX

Introduction: Gallstone is a rare cause of large bowel obstruction. It can result in a complete mechanical obstruction in the setting of underlying distal benign or malignant narrowing. Surgical management used to be the traditional treatment modality. We are presenting a case of complete large bowel obstruction secondary to an impacted gallstone in the setting of sigmoid diverticular narrowing treated by colonoscopy with Electrohydraulic Lithotripsy (EHL).

Case Description/Methods: A 79-year-old female with a history of uterine cancer presented with diffuse abdominal pain and constipation that progressively worsened over 10 days. Physical examination revealed abdominal distension. Lab work was unremarkable. CT abdomen revealed a cholecystocolonic fistula and a large bowel obstruction with colonic distension secondary to a 3 cm gallstone impacted in the sigmoid colon (Figure 1A). Conservative management failed. Surgery was deemed to be high risk and the patient was referred for possible endoscopic treatment. Colonoscopy revealed multiple small and large-mouthed diverticula in the sigmoid colon and a large impacted pigmented stone in an area of peri-diverticular colonic narrowing causing significant ulceration and superficial necrosis of underlying colonic mucosa. EHL was used, which resulted in the fragmentation of the impacted stone and successful advancement of the scope to the proximal colon with no signs of perforation (Figure 1B, 1C). Colonic obstruction resolved. The patient had multiple bowel movements after the procedure with complete resolution of the colonic obstruction and was discharged home.

Discussion: This case highlights the feasibility and safety of endoscopic management of gallstone large bowel obstruction using lithotripsy modalities, like EHL which could be considered a first-line approach.



Disclosures:


Bhavi Trivedi, MD¹, Jesus Guzman, MD², Mohammad Bashashati, MD³, Brian Davis, MD¹, Vital Rangashamanna, MD⁴, Ihsan Al-Bayati, MD⁴, Sherif E. Elhanafi, MD¹. P1740 - Break It Up: Gallstone Sigmoid Obstruction Treated with Electrohydraulic Lithotripsy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.