Acute cholecystitis as a complication of diverting loop ileostomy: A case series and narrative review

Abstract

Introduction: Diverting ileostomy is increasingly utilized in modern colorectal surgery for the management of colorectal cancer and inflammatory bowel disease (IBD) among other bowel pathologies. Cholelithiasis has known associations with ileostomy and IBD, potentially caused by changes to enterohepatic circulation and cholesterol absorption in the gallbladder. However, cases of cholecystitis following ileostomy have not been reported across the literature. Case Series: We present three cases of cholecystitis following diverting loop ileostomy in a 56-year-old female, 74-year-old female, and 73-year-old female. A digital literature search was conducted on databases PubMed and EMBASE in February 2023 covering literature from 1974 to 2023 to identify any further cases; however, none were identified. To our knowledge, these are the first reported cases of cholecystitis following ileostomy. Conclusion: We believe these three cases highlight that developing symptomatic gallstones following diverting ileostomy occurs, and patients should be carefully counseled of the risks preoperatively, and be educated of gallstone-related symptoms to enable early engagement of upper gastrointestinal surgeons for treatment. Additionally, we recommend preoperative gallbladder imaging and close monitoring prior to and after ileostomy formation for development of gallstone complications. Ultimately, this case series and narrative review lay the groundwork for further research investigating any causality between diverting loop ileostomy formation and development of complications of gallstone disease.