Biliary Ileus Research Articles

Gallstone Ileus Caused by a Cholecysto-Duodeno-Colic Fistula, Case Report And Literature Review

Abstract Introduction: Complex cholecysto-duodeno-colic fistulas are an extremely rare complication that can occur in patients with cholelithiasis. The aim of this article is to present the case of a pacient with cholecystoduodeno- colic fistula manifested with biliary ileus in a patient known for many years with cholelithiasis. Case report: We present the case of a 62 y/o male that was admitted in our clinic with the diagnosis of gallstone ileus. Emergency surgical intervention was needed. Intraoperatively we discovered a cholecysto-duodenocolic fistula complicated with gallstone ileus. During the operation we practiced retrograde cholecystectomy, closure of the fistulous tract (duodenoraphy, coloraphy), enterotomy and extraction of the calculus located inside the small intestine. The postoperative evolution was favorable. Conclusions: Cholecysto-duodeno-colic fistulas complicated with gallstone ileus are an extremely rare complication that can occur in patients with gallstones. In case of the occurrence of gallstone ileus, the surgical treatment is an emergency, being the only therapeutic technique that can save the patient’s life.

Gallstone ileus - the double challenge: case report and review of the literature

Gallstone ileus is a rare condition which occurs as an evolutive complication of biliary lithiasis. It occurs after stone migration from extrahepatic biliary tree to the digestive lumen, mostly through a biliary-enteric fistula. This condition involves repeated inflammatory relapses with the formation of local adhesions and generally requires a long evolution. The vast majority of patients with biliary ileus are third aged women who often have concomitant medical illnesses. Gallstone ileus surgery deals with the two components: bowel obstruction and biliary pole. Obstruction solving is approached as a surgical emergency and it requires an attitude adapted to the local situation. The attitude towards biliary surgery for gallstone ileus is a matter in debate. It could be one-stage surgery, elective surgery or expectancy and its choice is imposed by both local and general condition of the patient. We report the case of a middle-age woman whose first symptom of cholelithiasis was the gallstone ileus. Plain upright abdominal radiography revealed air-fluid levels with distended loops of the small bowel and pneumobilia. Laparotomy was decided and exploration revealed an impacted gallstone into the ileum and dense adhesions were found under the liver region. Enterolithotomy for gallstone removal was made. Postoperative evolution was uneventful with discharge on 7th day.

Minilaparotomy for biliary ileus: A different approach

Introduction: Biliary ileus is a rare cause of mechanical bowel obstruction and results from the passage of gallstones into the small bowel. Case presentation: 62-year old woman with episode of biliary ileus was underwent to minilaparotomy (5 cm) to extract gallstone from small bowel. In this particularly patient we used this approach, because we had highly suspicious diagnostic. The patient was discharged on postoperative day 5 without any complication. Conclusion: Minilaparotomy approach is a feasible option in centers without laparoscopy surgery, with excellent results when one-stage procedure is not considered.

Клиническое наблюдение синдрома Bouveret (билиарный илеус)

Background Biliary ileus is a rare cause of acute intestinal obstruction and is 1-4% of all cases of small bowel obstruction. Objective: to Analyze the current data of the world medical literature on the problem of biliary ileus, basic medical diagnostic techniques aimed at improving the provision of health care to patients with this pathology. Materials and methods the authors review the literature and 1 the author nablyudeniya Bouveret syndrome. Discussion Bouveret's Syndrome is a rare form of obstructive ileus due to obstruction of the biliary calculus in the presence of biliodigestive fistula output Department stomachs or 12-p K-CI. The main clinical sign is the presence of signs of intestinal obstruction. The final diagnosis is established during surgical intervention. Mortality after enterotomy with extraction of ureteral stones is about 12%, after an extended intervention - up to 30% Completed surgical treatment, enterotomy, anterolateral. Conclusions despite the fact that the variation of the biliary ileus, Bouveret syndrome, a rare pathology, it is necessary to remember about this cause intestinal obstruction. Special attention should be given to elderly patients with clinic intestinal obstruction.

О диагностике обтурационной желчнокаменной кишечной непроходимости

The purpose of the study To study results of diagnostics obstructive gallstone intestinal obstruction. Material and methods The analysis of 1357 case histories of patients with acute intestinal obstruction were hospitalized in clinics Ufa. Among them, 43 patients (3.2%) were the cause of intestinal obstruction gallstones, and among 18 965 patients operated on for gallstones in clinics Ufa (1973-2014gg.) Patients with obstructive gallstone ileus was 0.2%. The age of patients was 55 to 85 years, the average age of patients was 64,2 ± 5,3 years, so most of the patients were at an old age. Of these men was - 8 (18.6%) women - 35 (81.4%). Results and their discussion The article presents results of diagnostics obstructive gallstone intestinal obstruction in 43 patients. The role of fuzzy clinical symptoms caused by advanced old patients, diagnostic errors and detailed clinical picture biliarnogoileusa bearing intermittent character. Emphasis is placed on the role of history in the diagnosis of biliary search. The authors present results of the strategic use radiological, endoscopic and ultrasonic diagnostic methods. Refined ultrasound kriteriiobturatsionnoy intestinal obstruction caused by gallstones. Biliarnogoileusa important in the diagnosis, authors say, is the detection of radiological symptom aeroholii. It is shown that the most informative method is a diagnostic laparoscopy, wity following is the value of ultrasound imaging. Conclusion The targeted exclusion of biliary ileus due to a balanced approach to the assessment of clinical symptoms, correct choice of algorithm instrumental studies, accumulation of facts in most cases, correct diagnosis obstructive gallstone intestinal obstruction.

Usefulness of CT-scan in the diagnosis and therapeutic approach of gallstone ileus: report of two surgically treated cases

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.

Cholecystocolonic fistula: facts and myths. A review of the 231 published cases

Cholecystocolonic fistula (CCF) is the second most common cholecystoenteric fistula and is often discovered intraoperatively, resulting in a challenging situation for the surgeon, who is forced to switch to a complex procedure, often in old, unfit patients. Management of this uncommon but possible finding is still ill defined. An extensive review of 160 articles published from 1950 to 2006 concerning 231 cases of CCF was performed. CCF is mostly an affliction of women in their sixth to seventh decades and is rarely diagnosed preoperatively. Chronic diarrhea is the key symptom in nonemergency patients, but, in one-fourth of cases, CCF presents with an acute onset, mostly biliary ileus. In one-fourth of patients, a second hepatobiliary abnormality is present, including gallbladder cancer in 2% of cases. In uncomplicated cases, diverting colostomy is not performed anymore, and laparoscopy treatment has been described in specialized centers. Symptomatic treatment of concomitant biliary ileus (without treating CCF) is a feasible option. Resolution of colonic biliary ileus by interventional endoscopy is reported. CCF should be considered in differential diagnosis of diarrhea, especially in old, female patients. A possible second hepatobiliary abnormality should be always investigated. Extemporaneous frozen section should be performed if gallbladder cancer is suspected. Depending on clinical presentation, different treatments for CCF are indicated, ranging from minimally invasive procedures to extensive resection.

Medicolegal aspects in gastroenterology

Medical practice is under continual public scrutiny. There are increasing concerns on medical malpractice and its consequences - further deterioration of health and death. Public criticism of medical practice very often outrageous, but sometimes medical negligence is obvious. We are presenting basic medicolegal analysis of causation in cases of medical malpractice with subsequent fatal outcome. We are reporting on two cases from archives of Institute of Forensic Medicine. The selected cases (biliary ileus and pseudomembranous colitis subsequent to elective cholecistectomy) may reflect common gastroenterological pathology. The analysis of medical practice and its consequences, i.e. analyse of causation has been presented and commented in regard to the pertinent legislation. Doctors ought to be familiar with medicolegal aspects of their practice. This might affect them to improve the quality of health care, and to increase protection, both of health care personal and patients.

Íleo biliar. Papel del diagnóstico por la imagen

Íleo biliar. Papel del diagnóstico por la imagen

Gallstone ileus analysis of radiological findings in 27 patients

Purpose: We retrospectively compared the clinical value of plain abdominal film, abdominal sonography and abdominal CT in diagnosing gallstone ileus in 27 patients. Material and methods: 27 patients (23 women and 4 men, age range 58–96 years; mean age 71.5 years) with surgically proven gallstone ileus were submitted to plain film, sonography and CT of the abdomen. Abdominal plain films were performed in 19 cases in upright position (postero-anterior projection), in eight cases in supine position. Abdominal US were performed with 3.5 and/or 7.5 MHz probes. CT was performed with a helical unit (slice thickness 4 mm, reconstruction interval 4 mm, pitch 1.5), after intravenous contrast agent (120 ml) infusion (3 ml/s, 55 s acquisition delay from bolus starting) and using a power injector. The following findings were searched on: pneumobilia, air in gallbladder, cholecysto-digestive fistula, extraluminal fluid, bowel loops dilatation, intestinal air–fluid levels, ectopic stones. Results: Plain abdominal films showed the following findings: air–fluid levels (77.78% of cases), bowel loops dilatation (88.89%), site of obstruction (44.4%), pneumobilia (37.04%), air in gallbladder (3.70%), ectopic stone (33.33%). Abdominal sonography demonstrated bowel loops dilatation (44.44%), extraluminal fluid (14.81%), ectopic stones (14.81%), gallbladder abnormalities, (37.04%), pneumobilia (55.56%). CT findings retrospectively observed were: bowel loops dilatation (92.59%), air–fluid levels (37.04%), bilio-digestive fistula (14.81%), pneumobilia (88.89%), ectopic stone (81.48%), extraluminal fluid (22.22%). The Rigler’s triad, that is pneumobilia, bowel mechanical obstruction and ectopic stone detection was observed 4 times with RX (14.81%), 3 times with US (11.11%) and 21 times with CT (77.78%). Conclusions: Air–fluid levels and bowel loop dilatation were the radiological findings more frequently observed in our series. Plain abdominal film allowed us mainly to identify signs of obstruction, US were more effective in disclosing biliary pathology, CT allowed us to correctly diagnose biliary ileus with much higher accuracy.

Gallstone ileus as a complication of cholecystolithiasis

Biliary fistula and gallston ileus are rarely found. The diagnosis is difficult. Gallstone ileus requires urgent and appropriate surgical therapy. Enterolitotomy remains the gold standard of operative treatment for gallstone ileus, but additional procedures of one-stage cholecystectomy and repair of fistula are necessary. Some researchers advise first to resolve the gallstone ileus and then to perform the elective operation for gallstone disease in more ideal circumstances. Our case had clinical evidence of ileus, which was confirmed by radiological exam. Ultrasonographic examination performed before operation did not confirm the presence of gallbladder; it did not detect a large stone located in the intestine. The patient, a 75-year-old woman, was operated on. During the procedure it was shown that the second part of the duodenum was involved in a scar and displaced to the hepatic hilus. There was no gallbladder; it was probably destroyed by a long-lasting vesicoduodenal fistula. Cholangiography also did not detect the gallbladder. Biliary passage through the common bile duct was sufficient. The hole in the duodenum wall was sutured, and Kehr drain was inserted into the common bile duct. The gallstone was removed by incision of the intestine down to the obstruction. The postoperative period was complicated by a small suppuration of the laparotomy wound. Vesicoduodenal fistula present for a long time can lead to atrophy of the gallbladder. The one-stage procedure seems to be appropriate if biliary fistula and gallstone ileus are found.

Radiological findings in biliary fistula and gallstone ileus.

Biliary fistula and gallstone ileus are rarely found. The diagnosis is difficult and may be delayed until operation. We reviewed the radiological findings in a retrospective material. The cases of 16 patients treated for biliary fistula were analyzed with respect to findings at imaging. Ten patients had a spontaneous fistula. Nine of them had an internal bilioduodenal fistula and one had an external fistula with stones passing through a subcutaneous abscess. Five patients also had gallstone ileus and one patient a rare gastric outlet obstruction caused by a gallstone (Bouveret's syndrome). Six patients had an iatrogenic fistula. One of them had internal bile ascites and 5 an external fistula, one of which was a biliocystic fistula resulting from attempted hepatic cyst sclerotherapy. Various imaging modalities were used and there was often a delay in the diagnosis. Imaging did not show the fistula itself in any of the spontaneous cases. However, a nonvisualized or shrunken gallbladder seen at US often coexisted in these cases. CT yielded the diagnosis in one case of gallstone ileus, and a Gastrografin meal yielded it in the case of Bouveret's syndrome. Fistulography and cholangiography provided a correct diagnosis of fistula in all cases of iatrogenic biliocutaneous fistulas. Patients with biliary fistula usually undergo examinations with nonspecific results. The imaging findings could be more specific if the possibility of this diagnosis were remembered.

Radiological Findings in Biliary Fistula and Gallstone Ileus

Radiological Findings in Biliary Fistula and Gallstone Ileus

Biliary ileus: preoperative diagnosis by US. A report of two cases

The preoperative diagnosis of biliary ileus was correctly made by US in two cases (87 and 80-year-old females) referred to US studies because of nonspecific abdominal symptoms and to rule out possible acute appendicitis, respectively. Plain-film findings were unremarkable in one patient, small-bowel obstruction was detected in the latter. In both cases sonography revealed a small amount of air within the thick-walled gallbladder; the presence of mechanical ileus, and a gallstone impacted within the ileal loop. These features, together with collapsed bowel lumen distally to the stone, enabled a reliable diagnosis of biliary ileus to be made. This was confirmed by ensuing laparotomy, when a large cholesterol stone was removed in both cases.

Recurrent Cholelithic Intestinal Obstruction

Summary 1.Recurrent cholelithic intestinal obstruction is a rare condition and like its counterpart, primary gallstone intestinal obstruction, has a very high mortality rate. 2.Earlier preoperative diagnosis would facilitate the reduction of this rate in all cases of gallstone ileus. Aids in reaching the correct diagnosis are: (a) careful inquiry into the past history for gall bladder symptomatology; (b) serious consideration of gallstones in the differential diagnosis of intestinal obstruction; (c) more frequent recourse to radiographic studies, with no hesitation in the use of contrast media if flat plate films are not helpful; (d) close scrutiny of the roentgenograms for the diagnostic criteria of internal biliary fistula and gallstone ileus. 3.The exercise of certain prophylactic surgical procedures at the time of the operation for the first cholelithic obstruction might prevent recurrent obstruction of this type. 4.A case of recurrent intestinal obstruction due to gallstone—the fourteenth in the literature—is presented.

The roentgen diagnosis of gallstone ileus.

There are many communications in the literature describing gallstone or biliary ileus. In the period 1941 to 1950 88 papers on this subject were published. The majority of these are isolated case reports and few deal solely with the. radiographic diagnosis. Two factors serve to re-alert roentgenologists to an understanding and diagnosis of gallstone ileus. One is the high mortality of the disease; the other is the number of reports of gallstone obstruction from the surgical point of view which fail to mention the roentgen findings. As recently as 1950 a report (1) of 7 cases in which gallstone ileus was found at operation stated that “the roentgenographic examination appears to be of little value.” None of these cases were diagnosed before surgery. Denneen and Broderick (2) reported 1 case in a series of 10 which was recognized preoperatively. The present paper is based upon 8 cases in which the diagnosis was made or suggested prior to surgery or death. Four of these will be reported in some detail. In the opinion of the author, in the great majority of patients with this disease a diagnosis can easily be made. Early diagnosis is essential, since there is a notoriously long delay between the onset of symptoms and operation. The advanced age of most of the patients and concurrent cardiovascular-renal disease are additional reasons for the 50 per cent mortality which is the mean for this condition. In 1941, Rigler and his associates (3) reported 14 cases of gallstone ileus and discussed the diagnostic signs. The tenth published case of recurrent gallstone ileus was contributed by Noskin and Tannenbaum (4) in 1952. Lomhoff and Dubowy (5) reported a case of gallstone ileus associated with diverticulitis of the colon. The discovery of an obstructing calculus in the sigmoid, with the sigmoidoscope, was described by d'Abreu (6). Mayo and Brown (7), in 1949, reported the surgical aspects of 18 cases. Five diagnoses3 of mechanical ileus caused by an impacted gallstone were made at the Evanston Hospital from 1940 through 1951; this number represented 2.5 per cent of the 229 mechanical bowel obstructions in patients over eighteen years of age seen during that interval. This figure is in close agreement with those of Frimann-Dahl (8), 2 per cent, and of Rigler et al., 0.4 to 5.0 per cent. Recently Nemir (9) reported 8 cases of gallstone ileus treated surgically, representing 1.4 per cent of 549 cases of mechanical intestinal obstructions of all kinds. Erosion through the wall of the gallbladder into the alimentary canal is the common path by which a biliary calculus may gain entrance to the gut. A fistula is necessarily formed, usually cholecystoduodenal or cholecystojejunal. Rigler reported a choledochoduodenal fistula derived from the passage of a stone through the wall of the distal common duct into the duodenum. Many authors doubt if gallstones ever reach the intestine via natural channels.