Successful removal of an ileal gallstone by endoscopic ileocecal valvulotomy (with video)

 CommentaryBowel obstruction at the level of the ileocecal valve in an elderly person immediately raises the possibility of neoplasm and gallstone; in some areas of the world, ameboma or tuberculoma; and in the edentulous and diabetic, phytobezoar. Gallstone ileus was first described by Bartholin in the mid 1600s and today is suspected whenever a person, especially an elderly woman, presents with a small-bowel obstruction, Rigler's classic triad of air in the biliary tree or gallbladder, an ileus, and an ectopic gallstone are diagnostic. As for the endoscopic treatment here, the authors used their imagination to overcome the problem of a large stone stuck in a relatively small lumen. No one but the wearer knows exactly where a shoe pinches, and shoe fitters know you cannot reshape one's foot to fit into a new shoe. I am reminded of Carl Jung's observation that the shoe that fits one pinches another; there is no recipe for living that fits all cases—just as there is no one therapy that is right for all stones that got trapped in their journey.Lawrence J. Brandt, MDAssociate Editor for Focal Points

PII: S0016-5107(09)02435-3

doi: 10.1016/j.gie.2009.08.035

© 2010 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.