Colonoscopic treatment of gallstone ileus.

A 91−year−old nursing−home resident with dementia was admitted as an emer− gency with a 1−week history of lethargy, anorexia, constipation and abdominal distension. She was dehydrated and was assessed as having a Glasgow Coma Scale score of 9/15, which improved with fluid resuscitation. Her abdomen was distend− ed and tympanic, with obstructive bowel sounds. There were no palpable masses. She had significant cardiac morbidity, and laboratory tests showed a leucocyto− sis and an elevated urea concentration at 11.2 mmol/l. A plain abdominal radio− graph revealed grossly distended loops of large and small bowel. No air was seen in the biliary tree. No obstructing lesion was found on gastrograffin enema.