SURGICAL MANAGEMENT OF CHOLECYSTOENTERIC AND CHOLECYSTOCOLONIC FISTULAS IN GALLSTONE ILEUS: CASE REPORT

Abstract

Gallstone ileus (GI) is a serious complication of choledocho­lithiasis leading to high mortality because it manifests with mostly unspecific mechanical bowel obstruction symptoms such as abdominal pain, nausea, vomiting and constipation. Conservative treatment of GI is very rarely successful and non-invasive treatment methods provide ambiguous results. Surgery is the preferred treatment tactics for GI. The choice between surgical treatment types depends on the localization of the fistula between the gallbladder and the bowel, and patient’s general medical condition. Enterolithotomy is a surgical procedure proven to be safe and effective in pa­tients with multiple comorbidities who might experience intraoperative and postoperative complications if longer and extended surgeries were to be performed. For those patients who are healthy enough to avoid certain intra- and post-operative complications, the surgery type is chosen according to the anatomical site of the fistula. Cholecysto­duodenal and cholecystoenteric fistulas tend to close spon­taneously and only a minor part of them leave open leading to an increased risk of complications and to the need of a second-stage surgery. Therefore, a ‘watch and wait’ strategy could be implemented by performing enterolithotomy at first with the subsequent follow-up to check for the fistula closure. Cholecystocolonic fistulas do not tend to close na­turally, therefore they should be closed during a one-stage surgery as soon as possible in order to avoid the unwanted complications i.e., reflux cholangitis.