LAUSR

© BMJ Publishing Group Limited 2022. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A woman in her 70s previously diagnosed with gallstones was admitted to the hospital with myocardial infarction. There was STsegment elevation on her ECG. She underwent acute percutaneous coronary intervention with the placement of a drugeluting stent in her right coronary artery and subsequently lifelong anticoagulant therapy. After admittance, she had increasing abdominal pain and had no bowel function for 4 days. A CT scan showed a gallbladder with a thickened wall and a fistula to the right colic flexure with incomplete large bowel obstruction due to a gallstone of approximately 5×4.5×3 cm in the sigmoid colon (figure 1). The gallstone was located in the gall bladder 1 year earlier (figure 2). Bowel obstruction caused by gallstones is a rare complication to cholecystolithiasis. When occurring, the most common location of the obstruction is the terminal ileum (60%–85%). In only 4% of patients with gallstone ileus, the obstruction is in the sigmoid part of the colon. The probability of this is increased in the presence of diverticular disease. We present a case where we used endoscopic electrohydraulic lithotripsy (EHL) as a firstline strategy. EHL is a minimally invasive technique to fragment stones using a highvoltage electric spark between two isolated electrodes through a liquid. EHL works by creating a hydraulic shock wave that can generate pressure, fragmenting solid objects in its path. Under mild sedation, the stone was broken down and removed during a 2hour EHL session. During the subsequent inspection of the large bowel, multiple diverticula and a fibrotic sigmoid colon were found. See video.(video 1) The patient had recovered and could be discharged after 2 days. At 3month followup, the patient had normal bowel function and symptoms expectable in a patient with diverticulosis. EHL is an effective treatment for gallstones in the bowel. 4 This case presents an effective and successful treatment of sigmoid gallstone ileus in a highrisk patient using EHL. In stable patients suffering from large bowel obstruction