A CASE OF GALLSTONE ILEUS

Abstract

An obese 79-year-old diabetic woman was admitted with a history of intermittent abdominal pain and vomitting. Two years previously, she had been investigated in our hospital for cholecystolithiasis. Plain radiographs of abdomen with the patient supine revelaed air in the biliary tree and incomplete small-bowel obstruction. With the pre-operative diagnosis of gallstone ileus, laparotomy was performed, and 2.5cm calculus was removed from the jejunum. A large cholecysto-duodenal fistula was noted, but no further surgery was performed on account of high risk. Recovery was satisfactory and free from complications. We analyzed 160 cases of gallstone ileus in Japan with special reference to treatment. We classified gallstone ileus into four types, according to the number, position of the stones before they enter the bowels. In type 1, there was no difference in the incidence of complications between the ileus operation group and the ileus operation plus radical operation group. In types 2 and 3, the incidence of complications was significantly lower in the ileus operation plus radical operation group than in the ileus operaton group. These results suggested that surgical removal of gallstones that obstruct the intestine will have good results in type 1 patients, but that additional radical surgery should be undertaken primarily or secondarily in type 2 or 3 patients with gallstone ileus.