Gallstone ileus, experience in the Dr. Eduardo Liceaga General Hospital of Mexico

Abstract

Abstract Background Gallstone ileus is a rare cause of intestinal obstruction (1–4%). It results from the migration of a gallstone through a bilio-enteric fistula. Treatment begins with fluid therapy, followed by enterolithotomy, fistula closure, and cholecystectomy. Objectives To determine the clinical presentation in patients with gallstone ileus and subsequent medical-surgical management outcomes. Material and methods A retrospective, observational, descriptive and transversal study was conducted on patients diagnosed with intestinal obstruction secondary to a gallstone ileus from May 2013 to October 2014. The following variables were recorded: age, sex, comorbidities, mean time of onset of symptoms, length of preoperative and postoperative stay, imaging studies, biochemical tests, type of surgical management, stone location and size, complications, mortality, and postoperative follow-up. Results The study included 10 patients (male:female ratio, 1:4), with a mean age of 61.9 years. The mean time of onset symptoms 15.4 days, and preoperative stay was 2 days. On admission, 80% of patients had leukocytosis and neutrophilia, and 70% with renal failure. The most common surgical management was enterolithotomy with primary closure (50%), finding 80% of the stones in the terminal ileum. Recurrence was found in 2 cases. Mean postoperative hospital stay was 6.3 days. Mortality was 20%. Conclusions Gallstone ileus most commonly presented in women in the seventh decade of life, with intermittent bowel obstruction. On hospital admission, they presented with systemic inflammatory response, electrolyte imbalance and abnormal liver function tests. Initial treatment must include fluid-electrolyte replacement, and tomography scans must be made in all cases. In our experience, the best procedure is enterolithotomy and primary closure, which presented lower morbidity and mortality.