Multiple Biliary Stones: a Rare Long-term Complication after Whipple Procedure / Múltiplos cálculos biliares: uma complicação rara a longo prazo após o procedimento de Whipple

A hypertensive, diabetic woman underwent a successful Whipple procedure at the age of 84 due to carcinoma of the ampulla of Vater. She presented an extremely rare complication 24 months after the surgery, consisting of acute cholangitis due to multiple biliary lithiases associated with a bilioenteric anastomotic stricture. The diagnosis was confirmed with computed tomography, magnetic resonance cholangiopancreatography, and cholangiography. The patient was successfully treated with multiple percutaneous transhepatic cholangioplasties (AU)

Uma mulher hipertensa e diabética foi submetida a um procedimento bem-sucedido de Whipple aos 84 anos devido a um carcinoma da ampola de Vater e apresentou uma complicação extremamente rara 24 meses após da cirurgia, consistindo em colangite aguda devido à presença de litíase biliar múltipla associada com estenose da anastomose bilio-entérica. O diagnóstico foi confirmado com tomografia computadorizada, colangiopancreatografia por ressonância mag-nética e colangiografia.O paciente foi tratado com sucesso com múltiplas colangioplastias transhepáticas percutâneas (AU)

Incidencia de factores de riesgo para desarrollo de litiasis vesicular en pacientes menores de 40 años colecistectomizados en el hospital Dr. Ricardo Baquero González. Periodo enero 2019- diciembre 2021. Estudio retrospectivo / Risk factors for the development of vesicular lithiasis in patients under 40 years old cholecystectomy at Hospital Dr. Ricardo Baquero González. Period january 2019-december 2021. Retrospective study

El objetivo de la investigación es analizar la incidencia de los factores de riesgo para el desarrollo de colelitiasis en pacientes menores de 40 años colecistectomizados en el Hospital Ricardo Baquero González. Periodo enero 2019 ­ diciembre 2021.Método: Se realizó un estudio retrospectivo; se analizaron los datos de los de los pacientes diagnosticados e intervenidos por litiasis vesicular. Resultados: Arrojaron que la muestra fue de 151 pacientes; 70% es de sexo femenino y el 30% masculino. El 41% de los pacientes tiene menos de 40 años. En los factores de riesgo se destaca que el 42% son del tipo familiar, el 40% de las mujeres utiliza anticonceptivos orales y el 40% de los pacientes presenta sobrepeso. Conclusión: Se concluye que los casos de litiasis vesicular se encuentran asociados de forma mayoritaria al sexo femenino y a factores de riesgos familiares y al sobrepeso; en cuanto a las mujeres, hubo alta incidencia de casos de litiasis vesicular en aquellas que emplean anticonceptivos orales. Además, en la investigación se observó un aumento en los casos de litiasis vesicular en pacientes que no se encuentran dentro de los grupos de riesgo, como son mujeres menores de 40 años, con peso normal y con pocas gestas(AU)

he objective of the research is to analyze the incidence of risk factors for the development of cholelithiasis in patients under 40 years of age who underwent cholecystectomy at the Ricardo Baquero González Hospital. Period January 2019 - December 2021.Methodi: retrospective study was carried out; Data from patients diagnosed and operated on for gallstones were analyzed. Results: showed that the sample was 151 patients; 70% are female and 30% male. 41% of patients have an age under 40 years old. In the risk factors, it is highlighted that 42% are of the family type, 40% of the women in the sample use oral contraceptives and 40% of the patients are overweight. Concluded: From the investigation it is concluded that the cases of vesicular lithiasis are mostly associated with the female sex and family risk factors and overweight; As for women, there was a high incidence of cases of gallstones in those who use oral contraceptives. In addition, the investigation observed an increase in cases of gallstones in patients who are not within the risk(AU)

CA 19-9 levels in patients with acute pancreatitis due to gallstone and metabolic/toxic reasons

SUMMARY OBJECTIVE Acute pancreatitis (AP) is an important clinical event with an increased frequency due to increased life expectancy, obesity, and alcohol use. There are some data about the elevation of carbohydrate antigen (CA) 19-9 levels in benign and malignant pancreaticobiliary events in the literature, but in AP they are limited. The aim of this study was to evaluate the CA 19-9 level in patients with AP and determine its relationship according to the cause. METHODS Between 2010-2018, 173 patients evaluated with CA 19-9 levels as well as by standard laboratory tests were included in the study. CA 1 9-9 levels and laboratory findings were compared in patients with pancreatitis due to gallstone (group 1) and metabolic/toxic reasons such as hyperlipidemia, alcohol, or drug use (group 2). RESULTS There were 114 (66%) patients in the group 1 and 59 (34%) patients in the group 2. The majority of patients with high CA 19-9 level were in group 1 (92.1% vs 6.8%). CA 19-9 level, as well as amylase, lipase, AST, ALT and bilirubin levels were found to be statistically higher in patients with AP due to gallstone compared to patients with metabolic/toxic AP. CONCLUSIONS Patients with AP due to gallstone, were found to have a high level of CA 19-9 at admission. Early stage CA 19-9 levels may contribute to standard laboratory tests in the etiology of the disease in patients diagnosed with AP.

RESUMO OBJETIVO A pancreatite aguda (PA) é um evento clínico importante e cada vez mais frequente devido ao aumento da expectativa de vida, obesidade e do consumo de álcool. Existem alguns dados na literatura sobre a elevação dos níveis do antígeno carboidrato (CA) 19-9 em eventos pancreato-biliares benignos e malignos, mas eles são limitados em relação à PA. O objetivo deste estudo foi avaliar o nível de CA 19-9 em pacientes com PA e determinar sua relação com a causa da doença. PACIENTES E MÉTODOS Entre 2010 e 2018, 173 pacientes submetidos a uma avaliação dos níveis de CA 19-9, bem como testes laboratoriais padrão, foram incluídos no estudo. Os níveis de CA 19-9 e os achados laboratoriais foram comparados em pacientes com pancreatite devido a cálculos biliares (grupo 1) e razões metabólicas/tóxicas, como hiperlipidemia, álcool, ou uso de drogas (grupo 2). RESULTADOS Um total de 114 (66%) pacientes foi incluído no grupo 1 e 59 (34%) no grupo 2. A maioria dos pacientes com alto nível de CA 19-9 estavam no grupo 1 (92,1% versus 6,8%). O CA 19-9, bem como os níveis de amilase, lipase, AST, ALT e bilirrubina foram estatisticamente mais altos em pacientes com PA devido a cálculos biliares em comparação àqueles com PA devido a alterações metabólicas/tóxicas. CONCLUSÃO Pacientes com PA devido a cálculos biliares apresentaram um alto nível de CA 19-9 no momento da internação. O nível de CA 19-9 na fase inicial pode contribuir para testes laboratoriais padrão na etiologia da doença em pacientes com diagnóstico de PA.

Litiasis coledociana: resultados de la colangiografa intraoperatoria en nuestro medio / Choledocholithiasis: results of the intraoperative cholangiography in our community

The term choledocholithiasis refers to a condition when a gallstone or gallstones become lodged within any duct of the bile system. We can find pigment gallstones, cholesterol gallstones and mixed. During surgery to remove the gallbladder you may have a procedure called intraoperative cholangiogram to look for gallstones that may be in the common bileduct. Stones in the bile ducts are classified as either primary (arising the novo), secondary (migrating from the gallbladder), recurrent (reforming after biliary tract surgery) or retained (overlooked at the time of surgery). The prevalence of choledocholithiasis in patients with simptomatic gallbladder lithiasis can be a reason for enlargement of the hospital stay, and eventually in the complexity on the prevented surgical procedure. Our aim was to investigate its prevalence in our Hospital, and the results with the empoyement of the intraoperative cholangiography accordin to our surgical protoco, and the recognized guideliness from other Centers. The results obtained are discused

Complicación tardía por clips y cálculo, en paciente colesistectomisada / Late complication due to a clip and gallstone in a patient who underwent a cholecystectomy

RESUMEN Se presentó un caso con complicación tardía de una colecistectomía video-laparoscópica, cuatro años después de una colecistectomía laparoscópica. Se procedió a realizar la colangiopancreatografia retrograda endoscópica mediante la técnica convencional, por un especialista en Gastroenterología. Se procedió a realizar pre-corte papilar y se logró extraer el clip con pinza de biopsia. Se produjo la expulsión espontánea de un litio oscuro de aproximadamente 1 cm de diámetro (AU).

ABSTRACT We presented a case with late complication of a video-laparoscopic cholecystectomy, occurring four years after a laparoscopic cholecystectomy. A specialist in Gastroenterology carried out an endoscopic retrograde cholangiopancreatography using the conventional technique. A papillary pre-cut was done and the clip was extracted with biopsy clamp. A dark stone of around 1 cm of diameter was spontaneously passed (AU).

Obstrucción colónica por cálculo / Colonic obstruction by gallstone

El íleo biliar es una rara complicación de la colelitiasis, que se caracteriza por presentar clínicamente una obstrucción intestinal mecánica intraluminal, secundaria a la impactación de un cálculo biliar en el tubo digestivo, debido a la existencia de una fístula bilio-entérica. El diagnóstico preoperatorio es difícil, ya que presenta síntomas y signos de obstrucción intestinal, los cuales son muy inespecíficos para sospechar un íleo biliar. El tratamiento de elección en el manejo del íleo biliar es el quirúrgico. Habitualmente se realiza una cirugía en dos tiempos, enterolitotomía como único gesto, sin embargo no hay una técnica quirúrgica definitiva estandarizada. Presentamos el caso de una paciente de 70 años que acude al Departamento de Urgencias con el diagnóstico clínico de obstrucción intestinal mecánica baja, de cuatro días de evolución, como consecuencia de un cálculo impactado en colon sigmoides.

Gallstone ileus is a rare complication of cholelithiasis, which is characterized by clinically presenting as an intraluminal mechanical intestinal obstruction secondary to the impaction of a gallstone in the digestive tract, due to the existence of a biliary-enteric fistula. The preoperative diagnosis is difficult, since it presents symptoms and signs of intestinal obstruction, which are very unspecific to suspect a Biliary Ileus. The treatment of choice in the management of gallstone ileus is surgery; usually is performed in two stages, whole lithotomy as the only gesture, however there is no standardized definitive surgical technique. We present the case of a 70-year-old patient, who attended the emergency department with the clinical diagnosis of low mechanical bowel obstruction, four days of evolution, as a result of a stone impacted in the sigmoid colon.

El síndrome de Mirizzi, un desafío para el cirujano / Mirizzi syndrome, a challenge for the surgeon

El síndrome de Mirizzi es una inflamación poco frecuente y crónica ocasionada por un cálculo impactado en la bolsa de Hartmann con obstrucción parcial o completa del conducto biliar principal. Es una complicación prolongada de la enfermedad litiásica biliar e infiere un diagnóstico preoperatorio difícil, así como una compleja conducción terapéutica. El objetivo de este trabajo es realizar una actualización del tema sobre el diagnóstico y tratamiento de esta entidad. Se realizó una revisión de las bases de datos Pubmed, Dynamed y Conchrane (idioma inglés y español) en busca de los artículos relacionados con el síndrome de Mirizzi. Trabajos adicionales fueron identificados mediante búsqueda manual de las referencias de artículos relevantes. Se presentó una actualización detallada acerca del diagnóstico y tratamiento de esta entidad teniendo en cuenta la experiencia del autor y los hallazgos de la revisión realizada. Para lograr un diagnóstico preoperatorio e intraoperatorio certero se requiere un alto índice de sospecha, llevando a una óptima proyección quirúrgica para tratar esta entidad(AU)

Mirizzi syndrome is a rare and chronic inflammation, caused by a calculus stuck to the Hartmann bag, with partial or complete obstruction of the main bile duct. It is a lengthened complication of lithiasic biliary disease and effects a difficult preoperative diagnosis and a therapeutic complex treatment. To perform an updating about the of subject and to present the "state of art" diagnosis and treatment for this entity. A review of PubMed, Dynamed and Conchrane data was made (in both English and Spanish), looking for articles about Mirizzi syndrome. Additional papers were identified by manual search for references of relevant articles. A detailed updating on the diagnosis and treatment of this entity was presented, taking into account the experience of the author and the findings from the review. High suspicion index is required for an accurate preoperative and intraoperative surgical diagnoses leading to an optimal approach to treat this condition(AU)

Common Bile Duct Obstruction Due to a Large Stone at the Duodenal Stump / 대한소화기학회지

Enterolith is a rare complication of Billroth II gastrectomy. Most enterolith cases have been reported in association with diverticula, tuberculosis, and Crohn's disease. We report the case of a huge enterolith that developed in the duodenal stump following common bile duct obstruction and cholangitis, necessitating surgery. The enterolith was clearly visible on the abdominal computed tomography. It was removed through a duodenotomy. The surgery was successful without any significant complications.

Prevalence of gallstones in 1,229 patients submitted to surgical laparoscopic treatment of GERD and esophageal achalasia: associated cholecystectomy was a safe procedure / Prevalência de colelitíase em 1.229 pacientes submetidos ao tratamento cirúrgico laparoscópico de DRGE e megaesôfago: a colecistectomia associada mostra-se segura

BACKGROUND: Association between esophageal achalasia/ gastroesophageal reflux disease (GERD) and cholelithiasis is not clear. Epidemiological data are controversial due to different methodologies applied, the regional differences and the number of patients involved. Results of concomitant cholecistectomy associated to surgical treatment of both diseases regarding safety is poorly understood. AIM: To analyze the prevalence of cholelithiasis in patients with esophageal achalasia and gastroesophageal reflux submitted to cardiomyotomy or fundoplication. Also, to evaluate the safety of concomitant cholecistectomy. METHODS: Retrospective analysis of 1410 patients operated from 2000 to 2013. They were divided into two groups: patients with GERD submitted to laparocopic hiatoplasty plus Nissen fundoplication and patients with esophageal achalasia to laparoscopic cardiomyotomy plus partial fundoplication. It was collected epidemiological data, specific diagnosis and subgroups, the presence or absence of gallstones, surgical procedure, operative and clinical complications and mortality. All groups/subgroups were compared. RESULTS: From 1,229 patients with GERD or esophageal achalasia, submitted to laparoscopic cardiomyotomy or fundoplication, 138 (11.43%) had cholelitiasis, occurring more in females (2.38:1) with mean age of 50,27 years old. In 604 patients with GERD, 79 (13,08%) had cholelitiasis. Lower prevalence occurred in Barrett's esophagus patients 7/105 (6.67%) (p=0.037). In 625 with esophageal achalasia, 59 (9.44%) had cholelitiasis, with no difference between chagasic and idiopathic forms (p=0.677). Complications of patients with or without cholecystectomy were similar in fundoplication and cardiomyotomy (p=0.78 and p=1.00).There was no mortality or complications related to cholecystectomy in this series. CONCLUSIONS: Prevalence of cholelithiasis was higher in patients submitted to fundoplication (GERD). Patients with chagasic or idiopatic ...

RACIONAL: São controversas as relações entre megaesôfago e doença do refluxo gastroesofágico (DRGE) com colelitíase, especialmente a forma mais adequada de conduzir pacientes com ambas. Dados epidemiológicos são díspares devido às diversas metodologias aplicadas, às diferenças regionais e à quantidade de pacientes envolvidos. OBJETIVO: Estudar a prevalência de colelitíase em pacientes submetidos às operações de refluxo gastroesofágico e megaesôfago (chagásicos ou não) e a segurança da colecistectomia estar associada. MÉTODO: Análise retrospectiva de 1410 pacientes operados entre 2000 e 2013. Eles foram divididos em dois grupos: os com DRGE e operados por hiatoplastia/fundoplicatura a Nissen laparoscópicas e os com acalásia por cardiomiotomia e fundoplicatura parcial laparoscópicas. Foram coletados dados epidemiológicos, diagnóstico, a presença ou não de litiase biliar, tratamento cirúrgico efetuado, complicações clínicas ou cirúrgicas e mortalidade. Todos os grupos e subgrupos foram comparados. RESULTADOS: Foram estudados 1229 pacientes portadores de megaesôfago e/ou DRGE, operados por fundoplicatura com hiatoplastia, nos casos de DRGE, e cardiomiectomia com fundoplicatura, nos casos de megaesôfago, no período de 2000 a 2013, verificando-se presença de colelítiase ou colecistectomia prévia. A colelítiase ocorreu mais no sexo feminino (2,38:1) e na faixa etária entre os 50 e 70 anos. A prevalência global foi de 11,43%; 13,08% na DRGE, menor nos portadores de esôfago de Barrett (6,67%) sendo a diferença significativa (p=0,037); e 9,44% no megaesôfago, não havendo diferença significativa entre os chagásicos e os idiopáticos (p=0,677). Não houve mortalidade ou complicações relacionadas à colecistectomia nesta série. CONCLUSÕES: A prevalência de colelitíase é maior nos pacientes com DRGE do que nos com megaesôfago. Não há diferenças na prevalência de colelitíase nos pacientes com megaesôfago chagásico e não chagásico. É mais frequente litíase ...

Successful Stone Removal by Endoscopic Retrograde Cholangiopancreatography in Situs Inversus Totalis with Billroth-II Gastrectomy

No abstract available.

Removal of Choledocholith by Endoscopic Retrograde Cholangiopancreatography in a Situs Invsersus Patient / 대한소화기학회지

Situs inversus is an extremely rare autosomal recessive disease with left-right inversion of internal organs. It carries technical difficulties in diagnostic or therapeutic procedures. There have been a few case reports on stone extraction by ERCP in situs inversus patients. ERCP techniques in situs inversus can be classified into conventional method and mirror image method. In mirror image method, the procedure is performed with the patient in the right lateral decubitus position and the endoscopist on the patient's left side. Until now, there is no consensus about which method is better. Herein, we report an unusual case of choledocholithiasis in a patient with situs inversus who underwent ERCP for stone extraction by both conventional method and mirror image method.

Recent Advances in Management of Acute Pancreatitis / 대한소화기학회지

Acute pancreatitis is common but remains a condition with significant morbidity and mortality. Despite a better understanding of the pathophysiology of acute pancreatitis achieved during the past few decades, there is no specific pharmacologic entity available. Therefore, supportive care is still the mainstay of treatment. Recently, novel interventions for increasing survival and minimizing morbidity have been investigated, which are highlighted in this review.

Idosos em situação de rua ou vulnerabilidade social: facilidades e dificuldades no uso de ferramentas computacionais / Elderlies in street situation or social vulnerability: facilities and difficulties in the use of computational tools / Ancianos en situación de calle o vulnerabilidad social: facilidades y dificultades en el uso de herramientas computacionales

Este estudo teve por objetivo identificar as facilidades e dificuldades encontradas por idosos em situação de rua ou vulnerabilidade social, no uso do computador ou internet. É uma pesquisa qualitativa do tipo exploratório, de que participaram cinco idosos assistidos em uma Organização não Governamental situada na cidade de São Paulo. Os discursos foram analisados pela Técnica de Análise de Conteúdo e evidenciaram como facilidades, dentre outras, esclarecer dúvidas com os monitores, o estímulo para novas descobertas aliada a proatividade e curiosidade, desenvolvimento de novas habilidades. As dificuldades estavam relacionadas a questões físicas ou cognitivas, à falta de instrutor e de conhecimento para interagir com a máquina. Os estudos voltados para a população idosa em situação de rua ou vulnerabilidade social podem contribuir com evidências que direcionem a formulação de políticas públicas voltadas para essa parcela da população.

This study aimed to identify the advantages and difficulties encountered by older people living on the streets or social vulnerability, to use the computer or internet. It is an exploratory qualitative research, in which five elderlies, attended on a non-governmental organization located in the city of São Paulo, have participated. The discourses were analyzed by content analysis technique and showed, as facilities, among others, to clarify doubts with the monitors, the stimulus for new discoveries coupled with proactivity and curiosity, and develop new skills. The mentioned difficulties were related to physical or cognitive issues, lack of instructor, and lack of knowledge to interact with the machine. The studies focusing on the elderly population living on the streets or in social vulnerability may contribute with evidence to guide the formulation of public policies to this population.

Este estudio tuvo como objetivo identificar las facilidades y dificultades encontradas por las personas mayores en situación de calle o vulnerabilidad social, en el uso de computadores o internet. Se trata de una investigación cualitativa exploratoria, a la que asistieron cinco personas mayores, asistidos en una Organización no Gubernamental ubicada en la ciudad de São Paulo. Los discursos fueron analizados por la técnica de análisis de contenido y evidencian como facilidades, entre otras cosas, aclarar dudas con los monitores, el estímulo para nuevas descubiertas asociadas a la pro actividad y curiosidad y al desarrollo de nuevas habilidades. Las dificultades se relacionaban con cuestiones físicas o cognitivas, a la falta de instructor y falta de conocimiento para interactuar con la máquina. Los estudios direccionados para la población anciana en situación de calle o vulnerabilidad social pueden contribuir con evidencias que direccionen la formulación de políticas públicas en beneficio de esa parcela de la población.

Gallstone Disease Does Not Predict Liver Histology in Nonalcoholic Fatty Liver Disease

BACKGROUND/AIMS: We sought to examine whether the presence of gallstone disease (GD) in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) is associated with liver fibrosis and histological nonalcoholic steatohepatitis (NASH) score. METHODS: We included 441 Turkish patients with biopsy-proven NAFLD. GD was diagnosed in the presence of sonographic evidence of gallstones, echogenic material within the gallbladder with constant shadowing and little or no visualization of the gallbladder or absence of gallbladder at ultrasonography, coupled with a history of cholecystectomy. RESULTS: Fifty-four patients (12.2%) had GD (GD+ subjects). Compared with the GD- subjects, GD+ patients were older, had a higher body mass index and were more likely to be female and have metabolic syndrome. However, GD+ patients did not have a higher risk of advanced fibrosis or definite NASH on histology. After adjustment for potential confounding variables, the prevalence of GD in NAFLD patients was not associated with significant fibrosis (> or =2) (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.53 to 2.21; p=0.68) or definite NASH (OR, 1.03; 95% CI, 0.495 to 2.12; p=0.84). CONCLUSIONS: The presence of GD is not independently associated with advanced fibrosis and definite NASH in adult Turkish patients with biopsy-proven NAFLD.

Abdome agudo por obstrução por ileobiliar / Acute intestinal obstruction due to gallstone ileus

OBJETIVO: descrever a experiência na abordagem dos doentes com abdome agudo por obstrução por IB, desde o diagnóstico até o tratamento definitivo. MÉTODOS: estudo retrospectivo incluindo todos os casos de IB tratados em um período de 23 anos. De acordo com a abordagem cirúrgica realizada, os pacientes foram divididos em dois grupos (1) enterolitotomia com colecistectomia no segundo momento; e (2) enterolitotomia, colecistectomia e abordagem da fístula. RESULTADOS: Doze pacientes foram incluídos, sendo 11 mulheres (91,6%), com média de idade de 72,2 anos. Todos os pacientes apresentavam doenças associadas, principalmente hipertensão arterial sistêmica (75%). Dois pacientes não apresentavam sintomas significativos de obstrução intestinal. O diagnóstico de IB foi realizado em seis pacientes (50%) antes da laparotomia. O grupo 1 foi constituído de oito pacientes e o grupo 2 de quatro, e a morbidade foi, respectivamente, 33,3% e 8,3%. A mortalidade foi 16,6% (um paciente de cada grupo). CONCLUSÃO: O manejo do IB deve ser individualizado. O tratamento da obstrução mediante remoção do cálculo biliar por enterotomia proximal é a escolha inicial para o tratamento do IB. A colecistectomia e a correção da fístula bilioentérica podem ser realizadas juntamente com a remoção do cálculo, no entanto, em pacientes com comorbidades significativas, esses procedimentos devem ser realizados posteriormente.

OBJECTIVE: To perform a systematic review of the history, available image exams and clinical approach to the diagnosis and treatment of gallstone ileus. METHOD: Retrospective study in a university hospital including all cases of SBO treated over a period of 23 years. According to the surgical treatment the patients were divided into two groups: (1) enterolithotomy with cholecystectomy performed later (two-stage surgery); and (2) enterolithotomy, cholecystectomy and fistula closure (one-stage surgery). RESULTS: Twelve patients were included in the study, including 11 females (91,6%), with a mean age of 72.2 years. All patients presented associated diseases, mainly arterial hypertension (75%). All except one patient had multiple SBO symptoms. Gallstone ileus diagnosis was achieved in six patients (50%) before laparotomy. There were 8 patients in group 1 and 4 in group 2, and the morbidity was, respectively, 33.3% and 8.3%. Overall mortality was 16.6% (one patient in each group). CONCLUSIONS: Gallstone ileus should be suspected in the elderly with SBO symptoms. Early diagnosis can reduce post-operative complications. Treatment is urgent laparotomy, and surgical treatment must be individualized for each case. The majority of patients in this study were treated with enterolithotomy, with cholecystectomy being performed later in two symptomatic patients.