title: Gallstone ileus treated with non-surgical conservative methods: a case report.
abstract: BACKGROUND
  The preoperative diagnosis of gallstone ileus is challenging due to the variability of its presentation, often resulting in late diagnosis. Controversy remains regarding the management of gallstone ileus; surgery is the standard treatment, but also less invasive approaches have proven to be successful. We present an unusual case of gallstone ileus and its conservative treatment.
  
  
  METHODS
  We describe the case of a 49-year-old Caucasian woman with a bowel sub-occlusion, treated conservatively. The imaging technique (plain abdominal X-ray and computed tomography scan) led to a diagnosis of gallstones ileus. A surgical intervention was not performed. Instead, she underwent extracorporeal shock-wave lithotripsy to fragment the stones, mechanical intestinal dilatation for ileocolic stenosis and endoscopic removal of the gallstone. The presence of an apricot shell contributed to the bowel occlusion and was removed. The intervention was successful and without complications.
  
  
  CONCLUSIONS
  Given the variability of the gallstone ileus presentation, surgery could not be the only treatment for our patient. In our case report, we show that colonoscopy could be a non-invasive approach that allows for diagnosis and treatment at the same time. The available data do not show a higher rate of recurrent biliary disease in cases where this method has been used, therefore in select patients, a conservative treatment could be an effective solution.
authors.affiliation: Department of Gastroenterology and Endoscopy Unit, Sant'Anna University Hospital, v. A. Moro 8 203, 44124, Cona, Ferrara, Italy. a.pezzoli@ospfe.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pezzoli
authors.affiliation: Department of Gastroenterology and Endoscopy Unit, Sant'Anna University Hospital, v. A. Moro 8 203, 44124, Cona, Ferrara, Italy. antonellamaimone81@gmail.com.
authors.forename: Antonella
authors.initials: A
authors.lastname: Maimone
authors.affiliation: Department of Gastroenterology and Endoscopy Unit, Sant'Anna University Hospital, v. A. Moro 8 203, 44124, Cona, Ferrara, Italy. rex3@iol.it.
authors.forename: Nadia
authors.initials: N
authors.lastname: Fusetti
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E7HB, UK. e.pizzo@ucl.ac.uk.
authors.forename: Elena
authors.initials: E
authors.lastname: Pizzo
mesh_terms: D003113:Colonoscopy / Q000379:methods; D005260:Female; D042882:Gallstones / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed