Gallstone Ileus – A single center case series

Abstract

Introduction: Gallstone ileus is a rare complication of cholelithiasis that accounts for 1−3% of mechanic ileus of the small bowel. It is characterized by bowel obstruction secondary to gallstone impaction that results from a migration due to the existence of a bilioenteric fistula. Gallstone Ileus is more common in the elderly with more comorbidities which leads to a high morbidity rate. Consequently, a debate exists regarding the appropriate surgical strategy for emergency treatment of gallstone ileus. The aim of the present study was to evaluate different surgical approaches based on the authors’ recent experience and to analyze the clinical outcome. Case Series: Six patients were included, all females, with a mean age of 82 years. All patients had comorbidities, specially, cardiovascular diseases. Three of them had previous history of biliary pathology. Diagnosis was confirmed through computed tomography (CT) scan in five cases. The stone was in the ileum in three, jejunum in two, and duodenum in one patient; the mean stone size was 2.5 cm. Four patients were submitted proximal to enterotomy with the removal of the gallstone, one to gastrotomy and one to cholecystectomy and a cholecystoduodenal fistula closure. During the postoperative period, complications were recorded in three subjects, one patient died due to cerebrovascular accident. Conclusion: The main key in guiding patients with gallstone ileus is the timely diagnosis which is currently facilitated with the support of the use of CT scan. Taking into consideration the age and comorbidities of these patients, the surgical management should be as conservative as possible.