Gallstone ileus: Diagnostic and therapeutic dilemma

Andrew Camerota,Jeffrey Zavotsky,Shireesh Saurabh

doi:10.5348/ijcri-2011-12-71-cs-1

Andrew Camerota, Jeffrey Zavotsky + Show 1 more

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https://doi.org/10.5348/ijcri-2011-12-71-cs-1

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Journal: International Journal of Case Reports and Image	Publication Date: Jan 1, 2011
Citations: 8	License type: cc-by

Abstract

Introduction: Gallstone ileus is a rare complication of cholelithiasis but an established cause of mechanical bowel obstruction in the elderly. Concomitant co–morbidities are frequent in older patients and responsible for the high mortality rate. The aim of the present study was to evaluate and discuss different surgical approaches and to analyze the clinical outcome. Case Series: Over a period of two years, three patients with a mean age of 78 years presented with complains of abdominal pain, nausea and vomiting of approximately two days duration. Diagnosis of gallstone ileus was made on computed tomography (CT) scan, which showed cholecystoenteric fistula and small bowel obstruction at the point of impaction of the gallstone. All the patients underwent enterolithotomy without a follow up biliary tract surgery. The postoperative course was uneventful in all the cases. Conclusion: Gallstone ileus is a rare condition, occurring in elderly with multiple comorbidities. The appropriate surgical intervention remains

Highlights

Gallstone ileus is a rare complication of cholelithiasis but an established cause of mechanical bowel obstruction in the elderly
Abdominal radiograph was inconclusive and diagnosis was made on computed tomography (CT) scan, which demonstrated cholelithiasis, cholecystoduodenal fistula and small bowel obstruction with transition point at the level of impaction of gallstone in distal ileum
Doko et al showed that postoperative complications like wound infection, wound dehiscence, myocardial infarction, pneumonia are more likely to occur with one stage procedure when compared with simple enterolithotomy (61.1% to 27.3%) [4]

Summary

Introduction

Gallstone ileus is a rare complication of cholelithiasis but an established cause of mechanical bowel obstruction in the elderly. Gallstone ileus is associated with high morbidity and mortality as most patients are elderly with multiple co morbidities. Most authors recommend enterolithotomy alone on account of its lower morbidity, mortality and reports of spontaneous fistula closure [1, 2, 3, 4, 5, 6]. Abdominal radiograph was inconclusive and diagnosis was made on computed tomography (CT) scan, which demonstrated cholelithiasis, cholecystoduodenal fistula and small bowel obstruction with transition point at the level of impaction of gallstone in distal ileum.

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