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Abstract
BackgroundGallstone ileus is a rare cause of gastrointestinal obstruction, more frequent in elderly patients, whose treatment is essentially surgical, although some para-surgical and mini-invasive possibilities exist, allowing the solution of such obstructive condition in a completely non-invasive way.DescriptionIn our study, after reporting two cases of biliary ileus managed by our surgical division, we will analyze the most suitable diagnostic procedures and the therapeutic approaches to this pathology.ConclusionsGallstone ileus is a quite rare pathology in population, but affects more frequently elderly people; The treatment of this disease is mainly surgical.
Highlights
Gallstone ileus is a rare cause of gastrointestinal obstruction, more frequent in elderly patients, whose treatment is essentially surgical, some para-surgical and mini-invasive possibilities exist, allowing the solution of such obstructive condition in a completely non-invasive way.Description: In our study, after reporting two cases of biliary ileus managed by our surgical division, we will analyze the most suitable diagnostic procedures and the therapeutic approaches to this pathology
Gallstone ileus, the intestinal obstruction due to the migration of gallstones into the intestine lumen, is a quite rare occurrence that must be taken into account in the differential diagnosis of mechanical intestinal obstructions, mainly those affecting small intestine and particularily in elderly patients
We identify a gallbladder-duodenal fistula, a diverticulum at about 70 cm from the ileocecal valve and a large gallstone formation at ileocecal valve level; we proceed with the enterotomy, with gallstone removal and diverticulum resection with TA
Summary
The intestinal obstruction due to the migration of gallstones into the intestine lumen, is a quite rare occurrence that must be taken into account in the differential diagnosis of mechanical intestinal obstructions, mainly those affecting small intestine and particularily in elderly patients The diagnosis of this disease is often late, sometimes detected only during surgery, even if the current routine use of echography and, above all, of TC (more accurate) for abdominal emergencies, allows to detect such condition earlier. An x-ray of the abdomen is performed in urgency and highlights the presence of multiple air-fluid levels; in order to achieve a better knowledge of the patient’s situation, we decide to perform abdomen and pelvis TC with contrast which shows the classic triad of gallstone ileus: hard gallbladder, intestine loops distension and air-fluid levels, presence of gallstones in jejunum loops lumen (Figure 4). After 7 days of after-surgery hospitalization without complications, the patient is discharged in a good general condition
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