高龄患者胆囊-结肠瘘致巨大结石性肠梗阻一例OA

Summary To report the diagnosis and treatment of an elderly patient with gallstone ileus at the rectosigmoid junction caused by a cholecystocolonic fistula,and discusses the key points in selecting treatment strategies and operative techniques.A 93-year-old male was admitted to Sichuan Corps Hospital of Chinese People's Armed Police Forces on November 27,2025,presenting with postprandial discomfort,abdominal pain,and distension for one week.His symptoms began one week prior without an obvious cause and were accompanied by reduced flatus and bowel movements.His medical history included chronic cholecystitis with cholecystolithiasis for over 10 years,hypertension and cerebral infarction for 30 years,and permanent pacemaker implantation 5 years earlier.Admission workup revealed cardiac insufficiency,renal insufficiency,hypokalemia,and coagulopathy.Abdominal CT showed an oval hyperdense nodule(approximately 5.4 cm×3.4 cm)obstructing the rectosigmoid junction,with marked gas,fecal,and fluid accumulation causing proximal dilatation,predominantly in the colon.The gallbladder was ill-defined.A mixed-density nodule(approximately 2.5 cm×2.2 cm)in the gallbladder fossa appeared contiguous with the transverse colon lumen,suggesting a fistula,accompanied by pneumobilia.Multidisciplinary discussion confirmed the diagnosis of a gallstone migrated via an internal fistula causing intestinal obstruction.Given the patient's advanced age and multiple comorbidities,endoscopic management was chosen.An emergency conventional colonoscopy with snare attempted stone extraction on the day of admission was unsuccessful.As abdominal distension worsened,unsedated colonoscopy with holmium laser lithotripsy was performed two days later.Intraoperatively,a large,hard,and irregular stone was found impacted at the rectosigmoid junction and was successfully fragmented with the laser fiber.The patient's symptoms resolved quickly post-procedure.He was discharged on postoperative day 9 and recovered well with an uneventful follow-up.For elderly,high-surgical-risk patients who fail conservative management,endoscopy can be a first-line treatment.Rigorous assessment of treatment indications is essential.During the procedure,careful dynamic adjustment of equipment settings and position is necessary to prevent iatrogenic injury.