Holmium laser and stone basketing: an innovative treatment for gallstone sigmoid obstruction caused by cholecystocolonic fistula
Letter to the Editor

Holmium laser and stone basketing: an innovative treatment for gallstone sigmoid obstruction caused by cholecystocolonic fistula

Jicai Wang1 ORCID logo, Chengpeng Zhang2, Guangquan Zhang1, Fenfang Wu1, Xianjie Shi1

1Department of Hepatopancreatobiliary Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China; 2Department of Hepatopancreatobiliary, Thyroid and Vascular Surgery, Wuhan Third Hospital (Tongren Hospital of Wuhan University), Wuhan, China

Correspondence to: Xianjie Shi, MD. Department of Hepatopancreatobiliary Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025 Shennan Middle Road, Futian District, Shenzhen 518033, China. Email: shixj7@mail.sysu.edu.cn.

Submitted May 26, 2024. Accepted for publication Sep 10, 2024. Published online Oct 14, 2024.

doi: 10.21037/qims-24-1048

Introduction

Cholecystocolonic fistula (CCF) with biliary ileus (BI) is rare in clinical practice. After cholecystoduodenal fistula, CCF is the most common type of cholecystointestinal fistula (1,2). The preoperative diagnosis of this disease is difficult, and as most CCI with BI patients are elderly and have complications, mortality is high. To enhance our understanding of this condition, we compiled and analyzed the clinical data of a patient with congestive cardiac failure and brain injury admitted to the Wuhan Third Hospital in July 2021. We conducted a literature review of articles retrieved from the PubMed database to identify cases reported over the past few decades (from 1989–2021). This article sought to discuss the imaging findings, diagnosis and treatment of CCF with BI, to improve its diagnostic accuracy, and to explore standardized diagnostic and treatment approaches.

Case presentation

A 95-year-old male patient was admitted to the emergency department with a one-day onset of acute abdominal pain, originating in the upper right quadrant and subsequently migrating to the lower left quadrant over the course of several hours. He had a history of gallstones in the past, and a physical examination showed right upper and left lower abdomen tenderness, but no rebound tenderness. His laboratory test results were as follows: leukocyte: 12.6×109/L; neutrophil percentage: 82.5%; C-reactive protein: 88.5 mg/L; albumin: 38.5 g/L; total bilirubin: 32.1 µmol/L; direct bilirubin: 11.0 µmol/L; indirect bilirubin: 21.1 µmol/L; total bile acid: 16.0 µmol/L; blood glucose: 7.74 mmol/L; urea nitrogen: 9.6 mmol/L; uric acid: 455 µmol/L; and sodium: 135.0 mmol/L (Table 1). An abdominal computed tomography (CT) scan (Figure 1) revealed the presence of gallstones, CCF, BI, and the dilatation of the intrahepatic and extrahepatic bile ducts. Additionally, aortic CT angiography indicated the presence of aortic aneurysmal dilatation. An electrocardiogram showed paroxysmal atrial fibrillation and sinus bradycardia.

Table 1

Summary of the patient’s laboratory test results

Item Laboratory values Reference unit Normal ranges
Leukocyte 12.6×109/L 109/L 3.5–9.5
Neutrophil percentage 82.50% % 40–75
C-reactive protein 88.5 mg/L mg/L 0–5
Albumin 38.5 g/L g/L 40–55
Total bilirubin 32.1 μmol/L μmol/L 2–21
Direct bilirubin 11.0 μmol/L μmol/L 0–6
Indirect bilirubin 21.1 μmol/L μmol/L 2–20
Total bile acid 16.0 μmol/L μmol/L 0–10
Blood glucose 7.74 mmol/L mmol/L 3.9–6.1
Urea nitrogen 9.6 mmol/L mmol/L 3.1–7.2
Uric acid 455 μmol/L μmol/L 150–430
Sodium 135.0 mmol/L mmol/L 137–147
Figure 1 CT scan images of the patient in the coronal and horizontal plane. (A) Abdominal CT, blue arrow: enterolith. Yellow arrow: the fistula between the gallbladder and colon. Red arrow: dilatation of intrahepatic and extrahepatic bile ducts. (B) Red arrow: enterolith. CT, computed tomography.

The patient was administered intravenous anesthesia in the operating room on the second day following his admission. The patient was placed in the left lateral decubitus position with bent knees. During the surgical procedure, a team consisting of a urologist and gastroenterologist inserted a colonoscope through the rectum. Pedicled polyps with a diameter of about 1.5 cm could be seen 20 cm away from the anus, and an impacted gallstone with a diameter of about 5 cm could be seen 30 cm away from the anus. The gallstone was hard, the surrounding colon wall was obviously congested and edematous, and some colonic mucosa had superficial ulcers. A holmium laser (energy: 1.0 J, frequency: 15 Hz) was used for repeated lithotripsy under the ureteroscope (Figure 2A). Intestinal gallstones were partially extracted using stone basketing during colonoscopy, while the remaining colonic gallstones were expelled through fecal matter (Figure 2B,2C). The patient developed diarrhea on the third day after the operation, which improved after symptomatic treatment, and was discharged from the hospital on the eighth day after the operation. No complications occurred during the three-month follow-up period.

Figure 2 Holmium laser combined with basketing for stone extraction. (A) A holmium laser was used for repeated lithotripsy under the ureteroscope. (B,C) The intestinal gallstones were removed by stone basketing under the colonoscope.

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for publication of this article and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

Literature review

We searched the PubMed database to retrieve relevant articles (published between 1989–2021) using the following keywords: CCF and BI (Table 2). In total, 19 articles (3-21) were retrieved and reviewed, and the data of 20 patients (6 male and 14 female) were collected and reviewed. The median age of the patients was 78.45 years (range: 49–95 years). The main symptoms were digestive system symptoms (Figure 3), including abdominal pain (80%), vomiting (50%), constipation (50%), abdominal distension (30%), diarrhea (15%), and anorexia (10%). The patients’ laboratory examinations typically lacked specific findings, while the imaging studies primarily revealed the presence of cholelithiasis, enterolith, and intestinal obstruction. The examination methods included X-ray, CT, enteroscopy, and lower digestive tract radiography. Most patients (85%) underwent open surgery. In a few cases (10%) less invasive methods were used, including holmium laser lithotripsy, trephine incision, and loop colostomy. One patient (5%) discharged the stones spontaneously. Three cases were followed up for 1–8 months, and the curative effect was satisfactory. The cure rate was 90%. Of the patients included in our analysis, 2 (10%) succumbed to their conditions, while 3 (15%) experienced complications, such as aspiration pneumonia, acute renal failure with acute myocardial infarction, and incision infection.

Table 2

Summary of the demographic and clinical data of previous studies

No. Gender Age (years) Clinical manifestations Laboratory examination Imaging examination/s Therapeutic approaches Outcome Complication/s Follow-up duration (months)
1 F 81 Abdominal pain, diarrhea, vomiting NA X-ray: biliary air pattern Right hemicolectomy cholecystectomy, and fistula dissection Death Aspiration pneumonia No
2 F 87 Abdominal pain Elevated inflammation and alkaline phosphatase X-ray: dilated small bowel loops with air-fluid levels; CT: cholecystocolonic fistula, large bowel obstruction, and sigmoid perforation Hartmann’s procedure Cure NA NA
3 F 88 Abdominal pain, constipation, diarrhea, chill Elevated transaminases, alkaline phosphatase and GGTP urinalysis showed 1+ bacteria X-ray: bowel gas pattern and fecal impaction; colonoscopy: gallstone in the sigmoid colon Colotomy Cure No 1
4 M 67 Abdominal pain, vomiting NA X-ray: pneumobilia and distal colonic obstruction; CT: gallbladder wall thickening with fistulous tract to the hepatic flexure, and sigmoid colon gallstone Stone extracted by colonoscopy, open cholecystectomy, and excision of fistula Cure NA NA
5 F 85 Abdominal distention and pain, constipation and emesis NA CT: gallbladder wall thickening and large bowel obstruction; gastrografin enema: fistula between the gallbladder and the colon Cholecystectomy and resection of fistula, involving the segment of the colon Cure NA NA
6 F 80 Nausea, vomiting, constipation White cell count: 10.1×109/L; C-reactive protein: 144 mg/L X-ray: gaseous distension of the large bowel, and pneumobilia Loop colostomy Cure No 5
7 F 88 Abdominal pain NA Abdominal ultrasound: inflammatory changes of sigmoid; CT: egg-shaped, peripheral calcified structure in sigmoid, pneumobilia, and ascending colon calculus Hartmann’s procedure Death Acute renal failure, acute myocardial infarction No
8 M 78 Abdominal pain and distention, constipation NA CT: cholecystocolonic fistula, associated with diffuse parietal thickening of the sigmoid colon, and descending colon gallstone Laparotomy and enterolithotomy Cure NA NA
9 F 70 Abdominal pain, vomiting, fever, jaundice, pale stool, dark urine, abdominal distension, constipation White cell count: 15,600 mm3; neutrophil: 85%; bilirubin: 47 μmol/L; alkaline phosphatase: 220 U/L X-ray: intestinal obstruction; barium enema: filling defect in the sigmoid colon with large bowel obstruction Aparotomy, sigmoid colectomy, partial cholecystectomy, loop colostomy, and closure of colostomy Cure NA NA
10 M 73 Abdominal pain vomiting, bloody diarrhea White cell count: 11.8×109/L; hemoglobin: 145 g/L; creatinine: 786 μmol/L; international normalized ratio: 2.71 CT: cholecystoenteric fistula with gallstone in the transverse colon Open colectomy and gallstone removal Cure NA NA
11 M 78 Abdominal pain, vomiting, constipation Light leukocytosis X-ray: pneumobilia, small-bowel dilatation, and ectopic gallstones in the sigmoid colon; CT: intra and extrahepatic pneumobilia Laparotomy and right hemicolectomy Cure No NA
12 F 74 Abdominal pain and distention, constipation, nausea NA CT: gallstone in the mid-sigmoid colon, and cholecystocolonic fistula Conservative therapy Cure NA NA
13 M 87 Diarrhea NA CT: sigmoid colon obstruction, pneumobilia, and cholecystocolonic fistula Laparotomy, partial cholecystectomy, subtotal colectomy, an end ileostomy Cure NA NA
14 F 77 Abdominal distention and pain, emesis pH: 7.16; creatinine: 229 μmol/L CT: large bowel obstruction; sigmoidoscopy: impacted gallstone in the sigmoid colon Laparotomy, cholecystectomy, right colectomy, end ileostomy, and ileostomy closure 6 months later Cure NA NA
15 F 87 Abdominal distention, emesis Leukocytosis: 27.4×109/L; C-reactive protein: 94.1 mg/L X-rays: pneumobilia and dilated large bowel; CT: cholecysto-colonic fistula, impacted gallstone in the sigmoid colon, resulting in large bowel obstruction Open cholecystectomy, gallstone extracted by milking, retrograde into the hepatic flexure fistula defect, followed by fistula closure Cure NA NA
16 F 49 Abdominal pain, nausea, vomiting, constipation GGTP: 226 UL X-rays: dilated small bowel; CT: cholecysto-colonic fistula, and impacted gallstone in the sigmoid colon Laparotomy, enterolithotomy, and primary transverse closure of the colon Cure No 8
17 F 54 Abdominal pain, nausea, lack of appetite, absence of bowel movements Lactic acidosis: 2.8 mmol/L CT: pneumobilia, and cholecysto-colonic fistula, and impacted gallstone at the junction of the descending and sigmoid colon Endoscopic management, cholecystectomy, and fistula removal Cure No NA
18 F 88 Abdominal pain, constipation, lack of appetite C-reactive protein: 177 mg/L; alkaline phosphatase: 407 IU/L; aspartate aminotransferase: 60 IU/L; total bilirubin: 35 ìmol/L CT: gallstones, enhancing gallbladder wall, cholecysto-colonic fistula, pneumobilia, bile duct dilatation, large bowel dilatation, and impacted gallstone in the mid-sigmoid colon Trephine loop colostomy Cure NA NA
19 F 83 Abdominal pain NA X-rays: distended bowel; CT: cholecystocolonic fistula, and intestinal obstruction; colonoscopy: gallstone Laparotomy, enterolithotomy, and primary closure of the colon Cure Incision infection NA

F, female; M, male; NA, not applicable/available; CT, computed tomography; GGTP, gamma-glutamyltranspeptidase.

Figure 3 Clinical manifestations of CCF with BI. CCF, cholecystocolonic fistula; BI, biliary ileus.

Discussion

CCF with enterolith was first discovered during an autopsy by Thomas Bartholin in 1654. Courvoisier first reported 131 cases of BI in 1890 (22,23). The etiology and pathogenesis of CCF with BI are mainly cholecystitis caused by a gallstone (1); however, other rare causes include malignant tumors, trauma, amoeba infection, peptic ulcer, intestinal diverticulitis, a history of biliary surgery, Crohn’s disease, and traumatic or iatrogenic biliary tract injury (24-26). The incarcerated stone causes the recurrent inflammation of the gallbladder, which leads to wrapping adhesion between the gallbladder and adjacent organ colon, and finally the formation of a fistula between them. The onset of cholecystitis results in elevated gallbladder pressure, venous and lymphatic obstruction, gallbladder wall and mucosa congestion and edema, heightened vascular permeability, and significant exudate accumulation in the gallbladder, exacerbating the existing high pressure in the organ. With repeated attacks of cholecystitis, congestion, edema, thrombosis, and intestinal wall necrosis also occur in the colon wall adhering to the gallbladder. Finally, the high pressure in the gallbladder can lead to the penetration of the gangrenous gallbladder wall and the colon wall, and the formation of a CCF (27). Larger stones scan easily be embedded somewhere in the intestinal cavity and can eventually lead to BI.

Despite its distinct clinical presentation, the disease exhibits characteristics typical of mechanical intestinal obstruction. In this study, abdominal pain was observed in 16 patients (16/20), vomiting and constipation in 10 patients (10/20), abdominal distension in six patients, diarrhea in three patients, and anorexia in two patients. Other symptoms, such as chills (1/20), fever (1/20), jaundice (1/20), pale stool (1/20), and dark urine (1/20), were sporadic. The movement of stones in the intestine is facilitated by peristalsis, leading to intermittent, incomplete, and unpredictable obstructions. Elderly patients with biliary tract diseases, comorbidities, and protracted illness may develop severe water and electrolyte imbalances, infections, and peritonitis. Vigilance is required to detect intestinal perforation. It can occur at the site where the stones erode the intestinal wall, or it can be secondary to intestinal wall necrosis caused by excessive pressure in the intestinal cavity (28,29).

The X-ray characteristics of BI are (I) pneumobilium, (II) bowel dilation and a high gas-liquid level, (III) an ectopic stone shadow, and (IV) constant changes in the position of the stone shadow, and movements in the obstruction level (30). Cholecystography can be used to diagnose CCF during surgery. Pneumobilium, or gas contained in the gallbladder, is a specific imaging feature of CCF (31). In barium enema examinations, the barium may regurgitate into the gallbladder. Enteroscopy enables the precise localization of the fistula and the potential extraction of colonic stones, but the process is inherently logical. During endoscopic retrograde cholangiopancreatography examinations, contrast agents may be found in the colon after injection. CT imaging is capable of detecting biliary tract lesions, identifying fistula locations, and assessing intra-abdominal conditions, and thus can provide valuable insights into disease diagnosis and treatment planning (28). Magnetic resonance imaging has certain advantages in detecting the development of fistulas, and can provide more detailed image information from multiple angles and multiple sequences. Further, laboratory examinations and abdominal ultrasounds can provide additional insights for diagnostic purposes, but the latter is characterized by low resolution and positivity rates (28).

In terms of the treatment methods, intestinal stone removal, fistula repair, and the eradication of primary biliary tract disease should be carried out to correct the imbalance of water and electrolytes, and prevent and treat complications. Once the diagnosis is confirmed, the basic methods and requirements for surgical treatment are to open the intestine and remove the stones (or resect and anastomose the intestinal segments), relieve intestinal obstruction, and reasonably treat biliary diseases. The procedure can be categorized into either a one-stage or two-stage operation, with the option to select between traditional open surgery or laparoscopic surgery. After simple enterotomy and stone removal, the primary biliary tract disease is not eradicated, and patients can easily relapse, and upper gastrointestinal bleeding, gallbladder cancer, or cholangiocarcinoma may occur. Therefore, after the first-stage operation, the second-stage operation, including cholecystectomy, stone removal, biliary obstruction removal, and internal fistula repair, should be performed as soon as possible. If the patient’s physical condition allows, the aforementioned treatment steps can be completed at one time (32). However, most patients with the disease are old, weak, and sick. If the biliary tract is unblocked and the stones have been removed, no further operation is required. The biliary fistula may close by itself. Despite the lack of closure, the harm is less than the risk of reoperation (33).

The holmium laser, which is characterized by a wavelength of 2.1 µm, is a pulsed laser generated by a device using a laser crystal doped with yttrium aluminum garnet as the active medium. This medium is sensitized with ionized chromium, and incorporates thulium as the energy-transmitting ion, and holmium as the activating ion. The energy produced by the laser vaporizes the water located between the optical fiber tip and the target stone, creating microscopic vacuoles. This process facilitates the transfer of energy to the stone, resulting in its fragmentation.

The integration of holmium laser technology with endoscopic treatment for intestinal calculi represents a highly advanced approach within the realm of minimally invasive procedures. This combination facilitates the direct visualization of the calculi’s location and dimensions, thereby enabling the precise application of the holmium laser for therapeutic purposes. The holmium laser is characterized by its superior tissue penetration capabilities and precise thermal effects, which effectively disintegrate the calculi while minimizing collateral damage to surrounding tissues. Endoscopic technology facilitates the acquisition of real-time images, while the parameters of the holmium laser, including power and irradiation duration, can be tailored to the specific characteristics of the stone to optimize treatment outcomes. The benefits of this approach include reduced trauma, expedited recovery, shorter hospital stays, and diminished postoperative pain. Conversely, the limitations of employing holmium laser in conjunction with endoscopy for the treatment of intestinal stones include the substantial cost of the equipment, the elevated technical demands, and the need for specialized operators. Additionally, in cases involving intricate stone conditions, multiple interventions may be necessary to achieve complete removal.

Surgical treatment offers the distinct advantage of directly excising the stones, making it particularly appropriate for instances involving large or complex calculi. However, surgical intervention is accompanied by several drawbacks, including inherent surgical risks, extended recovery periods, potential hospitalization, and elevated associated medical costs.

The patient under our care was of an advanced age and had a history of frailty and chronic illness. The application of conventional surgical techniques would have presented significant risks associated with both the surgical procedure and anesthesia, as well as a heightened likelihood of postoperative complications. The imaging examination showed the presence of a stone in close proximity to the anus. Taking these factors into account, we opted to employ a combination of holmium laser and endoscopic techniques for treatment. Notably, this approach yielded favorable outcomes.

Conclusions

We presented a novel treatment approach for the management of CCF complicated with BI. The existing literature suggests that open surgery is the preferred treatment modality. However, alternative options, such as laparoscopic or non-surgical interventions, may be considered, provided they adhere to fundamental treatment guidelines. Given the varied and intricate nature of patient presentations, personalized and interdisciplinary care should be emphasized.

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-1048/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee (s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for publication of this article and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Ploneda-Valencia CF, Gallo-Morales M, Rinchon C, Navarro-Muñiz E, Bautista-López CA, de la Cerda-Trujillo LF, Rea-Azpeitia LA, López-Lizarraga CR. Gallstone ileus: An overview of the literature. Rev Gastroenterol Mex 2017;82:248-54.
  2. Chick JF, Chauhan NR, Paulson VA, Adduci AJ. Cholecystocolonic fistula mimicking acute cholecystitis diagnosed unequivocally by computed tomography. Emerg Radiol 2013;20:569-72.
  3. Mohamed ZK, Balupuri S, Boobis LH. Colonic gallstones: a case report. Hepatobiliary Pancreat Dis Int 2007;6:324-5.
  4. D'Hondt M, D'Haeninck A, Penninckx F. Gallstone ileus causing perforation of the sigmoid colon. J Gastrointest Surg 2011;15:701-2.
  5. Patel SA, Engel JJ, Fine MS. Role of colonoscopy in gallstone ileus:--a case report. Endoscopy 1989;21:291-2.
  6. Gelbman A. Clinical quiz. Gallstone ileus with cholecystocolonic fistula. Emerg Radiol 2006;12:199-200.
  7. Gupta C, Malani AK, Ammar H. Cholecystocolonic fistula with impacted sigmoid gallstone mimicking malignant obstruction of the sigmoid colon. Scand J Gastroenterol 2007;42:535-6.
  8. Carlsson T, Gandhi S. Gallstone ileus of the sigmoid colon: an extremely rare cause of large bowel obstruction detected by multiplanar CT. BMJ Case Rep 2015;2015:bcr2015209654.
  9. Schoofs C, Vanheste R, Bladt L, Claus F. Cholecystocolonic fistula complicated by gallstone impaction and perforation of the sigmoid. JBR-BTR 2010;93:32.
  10. Laxague F, Ramos PM, Zanfardini A, Schlottmann F. Pathophysiology, Diagnosis, and Treatment of Colonic Gallstone Ileus in an Elderly Patient. ACG Case Rep J 2020;7:e00363.
  11. Sinha S, Pullan RD. Cholecystocolonic fistula: an unusual cause of large bowel obstruction. Br J Hosp Med (Lond) 2006;67:434-5.
  12. Hajjar R, Létourneau A, Henri M, Heyen F, Latulippe JF, Poirier M, Tremblay JF, Trépanier JS, Bendavid Y. Cholecystocolonic fistula with a giant colonic gallstone: the mainstay of treatment in an acute setting. J Surg Case Rep 2018;2018:rjy278.
  13. Roade Tato L, Ventura Cots M, Riveiro-Barciela M. Gallstone ileus secondary to a cholecystocolonic fistula. Gastroenterol Hepatol 2018;41:510-1.
  14. Hurst KV, Peiris GB, Booth M. Conservative management of the colonic gallstone. BMJ Case Rep 2021;14:e243040.
  15. Reddy AK, Dennett ER. Cholecystocolonic fistula: a rare intraluminal cause of large bowel obstruction. BMJ Case Rep 2016;2016:bcr2016217141.
  16. Cheong J, Gilmore A, Keshava A. Gastrointestinal: Cholecystocolonic fistula: A rare cause of large bowel obstruction. J Gastroenterol Hepatol 2016;31:909.
  17. Toh JW, Balasuriya H, Stewart P. An Unusual Cause of Large-Bowel Obstruction: Cholecystocolonic Fistula and Gallstone Ileus. Clin Gastroenterol Hepatol 2016;14:e107-8.
  18. Mauricio GU, David Eugenio HG, Enrique QF. Gallstone ileus of the sigmoid colon caused by cholecystocolonic fistula: A case report. Ann Med Surg (Lond) 2018;31:25-8.
  19. Sigmon L, Rejeski J, Marion B, Fina M. Colonic gallstone ileus. BMJ Case Rep 2017;2017:bcr-2017-220898.
  20. O'Brien JW, Webb LA, Evans L, Speakman C, Shaikh I. Gallstone Ileus Caused by Cholecystocolonic Fistula and Gallstone Impaction in the Sigmoid Colon: Review of the Literature and Novel Surgical Treatment with Trephine Loop Colostomy. Case Rep Gastroenterol 2017;11:95-102.
  21. Pinotti E, Montuori M, Ciocca Vasino M. Cholecystocolonic fistula presenting with intestinal obstruction. Dig Liver Dis 2020;52:462.
  22. Alemi F, Seiser N, Ayloo S. Gallstone Disease: Cholecystitis, Mirizzi Syndrome, Bouveret Syndrome, Gallstone Ileus. Surg Clin North Am 2019;99:231-44.
  23. Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL. Gallstone ileus, clinical presentation, diagnostic and treatment approach. World J Gastrointest Surg 2016;8:65-76.
  24. Abou-Saif A, Al-Kawas FH. Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Am J Gastroenterol 2002;97:249-54.
  25. Ha GW, Lee MR, Kim JH. Cholecystocolic fistula caused by gallbladder carcinoma: preoperatively misdiagnosed as hepatic colon carcinoma. World J Gastroenterol 2015;21:4765-9.
  26. Naitoh I, Nakazawa T, Miyabe K, Mizoguchi K, Kimura M, Takeyama H, Joh T. A cholecystocolonic fistula caused by penetration of a double-pigtail plastic stent after endoscopic transpapillary gallbladder stenting. Endoscopy 2015;47 Suppl 1 UCTN:E399-400.
  27. Correia MF, Amonkar DP, Nayak SV, Menezes JL. Cholecystocolic fistula: a diagnostic enigma. Saudi J Gastroenterol 2009;15:42-4.
  28. Chang L, Chang M, Chang HM, Chang AI, Chang F. Clinical and radiological diagnosis of gallstone ileus: a mini review. Emerg Radiol 2018;25:189-96.
  29. Inukai K. Gallstone ileus: a review. BMJ Open Gastroenterol 2019;6:e000344.
  30. Lassandro F, Romano S, Ragozzino A, Rossi G, Valente T, Ferrara I, Romano L, Grassi R. Role of helical CT in diagnosis of gallstone ileus and related conditions. AJR Am J Roentgenol 2005;185:1159-65.
  31. Abbasi SU, Khan DB, Khandwala K, Raza R, Memon WA. Cholecystocolonic Fistula. Cureus 2019;11:e4874.
  32. Pezzoli A, Maimone A, Fusetti N, Pizzo E. Gallstone ileus treated with non-surgical conservative methods: a case report. J Med Case Rep 2015;9:15.
  33. Dumonceau JM, Devière J. Novel treatment options for Bouveret's syndrome: a comprehensive review of 61 cases of successful endoscopic treatment. Expert Rev Gastroenterol Hepatol 2016;10:1245-55.
Cite this article as: Wang J, Zhang C, Zhang G, Wu F, Shi X. Holmium laser and stone basketing: an innovative treatment for gallstone sigmoid obstruction caused by cholecystocolonic fistula. Quant Imaging Med Surg 2024;14(12):9730-9737. doi: 10.21037/qims-24-1048

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