Rare Complication Of Cholelithiasis Research Articles

The Gallstone Ileus, a Retrospective Study and Review of the Literature

Introduction: Gallstone ileus (GI) is a rare complication of cholelithiasis and is one of the most irregular forms of all mechanical bowel obstructions. It is, however, a more common cause of non-strangulating mechanical small bowel obstruction, accounting for 1% to 4% of all patients and up to 25% in the elderly.
 The diagnosis is often delayed since symptoms may be intermittent, and investigations may fail to identify the cause of the obstruction. As a result, gallstone ileus continues to be associated with relatively high rates of morbidity and mortality.
 The cornerstone of healing is the removal of the stone that represents obstruction. As is the case with cholelithiasis, women are more frequently affected.
 Material and Methods: This article aims to review the incidence of gallstone ileus in our country in the literature, addressing the pathophysiology, clinical presentation, radiological findings, and treatment options. A literature search was done on gallstone ileus for 2005-2018.
 Results: The patients in the study presentation were both genders and older. They all came to INP because of abdominal pain and general nausea. All had CRP elevation present. Leukocytosis was present in only 2/3 of patients. AST was elevated in one patient and ALT in 2. All changes in laboratory parameters indicate the instability of marker changes and, consequently, the unreliability of use alone without other diagnostic methods. A CT scan was performed on all three patients, but one still needed to be uploaded to the system at the time of writing.
 Conclusions: Ileus due to gallstones is a rare disease. It is an uncommon cause of mechanical small bowel obstruction. It is a rare complication of chronic cholecystitis and occurs when a gallstone passes through a fistula between the gallbladder and small bowel before becoming impacted at the ileocecal valve. The use of radiological imaging is invaluable in the diagnosis of gallstone ileus. These authors recommend a low threshold for investigation. There is evidence for using AXR as a quick first-line investigation; however, CT scanning is a powerful and gold-standard tool to diagnose the condition and guide its management.

Surgical treatment of gallstone ileus caused by cholecystoduodenal fistula: A case report

Introduction: Gallstone ileus is a rare complication of cholelithiasis caused by bilioenteric fistula. Beside clinical examination CT scan is the considered radiological diagnostic procedure. Presentation of case: 68-year old male patient presented with epigastralgia, nausea and emesis. Abdomen was distended and diffusely painful to palpation with peritoneal irritation. Auscultation showed raised peristaltic sounds. CT scan showed aerobilia, distension of stomach, duodenum and proximal jejunum and inside it a 3.5 cm calcified round foreign body. Exploratory laparoscopy showed jejunum obstruction and chronic inflammation of gallbladder. Lifting the small bowel through small laparotomy was performed for gallstone removing. After recovery a delayed cholecystectomy and fistula closure followed. Hospital stays were short and complications-free. Conclusion: It is necessary to solve both, ileus and fistula, to prevent new bowel obstruction. The 2-step surgical procedure is a save treatment option, extraction of gallstone from bowel first, followed by delayed cholecystectomy and fistula closure.

Íleo biliar: análisis de 21 casos

Background: Gallstone ileus is a rare complication of cholelithiasis and mainly affects elder women. It is caused by gallstone migration through a cholecystoenteric fistula producing bowel obstruction, with the need for surgical treatment. Objective: The aim of this work was to describe the preoperative, intraoperative and postoperative variables of a case series of gallstone ileus and the incidence of recurrent gallstone ileus. Material and methods: We conducted an observational and retrospective study of patients undergoing surgery due to acute bowel obstruction caused by gallstone ileus between January 2009 and December 2021. The variables analyzed were imaging tests, comorbidities, surgical approach, type of surgery, morbidity and mortality and recurrent ileus. Results: Of 667 patients admitted with bowel obstruction, 21 had gallstone ileus (3.1%). The diagnosis was made by computed tomography scan in 80% of the cases. The surgical approach was laparotomy in 20 cases and 1 patient undergoing laparoscopy required conversion. Enterotomy with enterorrhaphy was the most common procedure used in 18 cases. The obstruction was treated by immediate surgery, while the biliary fistula was deferred in most cases because the risk of immediate treatment was very high. Morbidity was 38% and recurrence of gallstone ileus 4.7%. No deaths were reported. Conclusion: Gallstone ileus was a rare condition that was correctly diagnosed and timely treated with surgery, with a low incidence of recurrent gallstone ileus.

Gallstone Ileus: A Stone In The Way

Gallstone ileus, a rare complication of cholelithiasis, is caused by an impaction of gallstones within the gastrointestinal tract leading to mechanical intestinal obstruction. Here in, we describe a case of gallstone ileus in a 62-year-old woman successfully treated with enterolithotomy. The patient was discharged home after an uneventful post-operative period. Gallstone ileus is an uncommon complication of gallstones and a rare cause of intestinal obstruction, with often delayed presentation and non-specific symptoms. The preferred approach is enterolithotomy. Elective cholecystectomy after the acute episode is controversial.

Enterolithotomy for Gallstone Ileus: An Uncommon Cause of Intestinal Obstruction

Gallstone ileus is a rare complication of cholelithiasis which represent 1-3% of the causes of intestinal obstruction in the general population and is more commonly seen in females. Gallstone ileus does not present with unique symptoms, making the diagnosis difficult. Symptoms are often non-specific with intermittent intestinal obstruction. The management is surgical, but there is no consensus as to which of the different surgical techniques is the procedure of choice. We report an interesting case of a 78-year-old male brought to casualty with abdominal pain following a history of fall. Managed as a case of blunt trauma abdomen initially. Surprisingly investigations showed features of small bowel obstruction, a hyperdense structure in the distal jejunum with dilated proximal jejunal loops suggestive of gallstone ileus. The patient had undergone exploratory laparotomy with enterotomy and removal of gallstones without any postoperative complications. Intraoperatively cholecystoduodenal fistula was identified and the patient was electively planned for cholecystectomy and fistula repair.

Gallstone Ileus with A Typical Clinical Presentation: A Case Repor

Introduction: Gallstone ileus is a rare complication of cholelithiasis, described as a mechanical intestinal obstruction due to the impaction of one or more large gallstones within the gastrointestinal tract. It is caused by the passage of a gallstone from the bile ducts into the intestinal lumen through a fistula. The most frequent type of fistula is located between the gallbladder and the duodenum. Clinical Case: A 60-year-old male was admitted with a diagnosis of DM 2 / hypovolemic shock / upper gastrointestinal bleeding. Began 24 h before admission, presented asthenia, adynamia, hyporexia, tolerating only a liquid diet, 3 vomits of gastric contents and one melenic evacuation. level of care for surveillance and diagnostic protocol, upon admission to this hospital he presented vomiting in coffee grounds and hypotension that responded to intravenous fluids. An exploratory laparotomy was performed, finding: obstruction of the small intestine by a gallstone of approximately 7 cm in diameter at 170 cm from the angle of Treitz, reactive appendicitis, and abundant inflammatory reaction fluid; Enterolithotomy + primary closure was performed with the Heineke-Mikulikcz technique and a Penrose drain was placed into the pelvic cavity. Discussion: Intestinal obstruction caused by gallstones is rare, this event occurs more frequently in the elderly. The clinical picture is often diffuse and requires a high index of suspicion. Conventional radiography can be of great help for its diagnosis, but also Abdominal Ultrasound and Computerized Axial Tomography. Surgical treatment can range from enterotomy and lithotomy, which is the simplest, to enterotomy with lithotomy plus cholecystectomy, and fistula treatment, which is a complex procedure.

Gallstone Ileus: A Rare Surgical Emergency

Background : Gallstone ileus is a rare complication of cholelithiasis and is an uncommon cause of intestinal obstruction accounting for 1%–4% of mechanical bowel obstructions. This usually results from luminal impaction of one or more gallstone.
 Case Presentation : A 86-year-old male presented with the history of bilious vomiting for 15 days and abdominal distension for 8 days and diagnosed as a case of intestinal obstruction due to gall stone ileus. He was treated surgically by laparotomy followed by enterotomy and removal of gall stone were performed from the proximal ileum.
 Conclusion : Early diagnosis and treatment are important otherwise adverse effect of mechanical bowel obstruction leads to bad prognosis.
 Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 57-59

Cholecystocolonic fistula, a rare complication of cholelithiasis: case presentation

Introduction: Cholecystocolonic fistula is usually a rare and late complication of gallstones and is the second most common cholecystoenteric fistula. Objective: To present the case of a cholecystocolonic fistula, a rare complication of cholelithiasis. Presentation of the case: A 50-year-old female patient who comes to our institution for recurrent abdominal pain. Discussion: Patients with FCC usually have a variable clinical presentation and are more often asymptomatic. When symptomatic, patients generally present with diarrhea, abdominal pain, jaundice, fever, nausea, vomiting, steatorrhea, and weight loss. The combination of pneumobilia, chronic diarrhea, and vitamin K malabsorption has been proposed as a pathognomonic triad for cholecystocolonic fistula. Conclusions: Cholecystocolonic fistula is a rare entity, radiologists should be aware of it and should be carefully informed if it occurs together with other hepatobiliary anomalies. The clinical triad pneumobilia, chronic diarrhea, and prolonged prothrombin time is seen in less than one third. Almost three quarters of the cases are asymptomatic and are diagnosed intraoperatively. Where cholecystectomy and repair of the colon wall is the most used treatment method.

Delayed presentation to regional hospital of gallstone ileus

Gallstone ileus is a rare cause of mechanical intestinal obstruction accounting for less than 1% of obstructions and results from the migration and impaction of a gallstone within the gastrointestinal tract. It is a rare complication of cholelithiasis seen in as little as 0.3% of patients. Morbidity associated with gallstone ileus has been reported as up to 27% and mortality rate has been reported at rates ranging from 7% to 30%, this is attributed to advanced age, and delay to presentation at treatment. An 86-year old male who presented to a rural hospital with signs and symptoms consistent with small bowel obstruction and imaging demonstrating features consistent with gallstone ileus. Diagnosis was made on computed tomography (CT) of a small bowel obstruction secondary to a large impacted gallstone. Our case highlights the ongoing utility and diagnostic value of abdominal X-ray, particularly in rural facilities with limited resources. The case also highlighted the approach of laparoscopic assisted removal of gallstone alone in medically comorbid patients, in rural facilities and particularly in the elderly population who may not be fit for longer initial surgical procedures or subsequent procedures to close choledochoduodenal fistula.

Gall stone ileus: An uncommon cause of small bowel obstruction at an unusual age: A Case report

Gallstone ileus is a rare complication of cholelithiasis. It is an uncommon cause of a mechanical small bowel obstruction. Repeated episodes of cholecystitis results adhesion of the gallbladder to the small bowel (usually duodenum) with eventual formation of cholecystoenteric fistula via which gallbladder stone enters the small bowel. It is most commonly seen in elderly females hence linked with high morbidity & mortality. Computed tomography (CT) imaging have made it easier to diagnose gallstone ileus effectively. Surgical intervention results in prompt relief of obstructive symptoms by removing stone & repairing fistula. Here is a case of gall stone ileus in a 27-year-young gentleman who presented to us with history of acute abdomen & without any comorbidities or biliary manifestation.

A206 GALLSTONE IMPACTION IN THE DESCENDING COLON WITH SUCCESSFUL ENDOSCOPIC REMOVAL

BackgroundGallstone impaction in the colon is a rare complication of cholelithiasis, typically because of gallstones migrating into the colon via a cholecystocolonic fistula. Gastrointestinal obstruction from gallstones only develops in 0.3–0.5% of patients with cholelithiasis and accounts for 0.095% of all mechanical bowel obstruction. Successful treatment has been described with endoscopic and surgical techniques.AimsThis report aims to present a case of colonic obstruction from gallstone that was successfully treated endoscopically.MethodsWe conducted a retrospective chart review on one patient including assessing the history of presenting illness along with biochemical, radiographic, and endoscopic results. We then conducted a narrative literature review on this subject matter.ResultsAn 85-year-old male with known cholelithiasis complicated by prior cholecystitis presented with a 2-day history of generalized abdominal pain. Computed tomography (CT) showed fistulisation between the gallbladder and hepatic flexure. Follow-up CT with rectal contrast showed lack of contrast beyond an impacted gallstone in the descending colon (Figure 1A, 1B). The patient was deemed a poor surgical candidate thus endoscopic gallstone extraction was attempted. With a pediatric colonoscope, the 41mm x 51mm gallstone was visualized 70cm from anal verge (1C). The stone was too large to be extracted en-block with snare or basket. Attempts to cut the stone at its surface with a polypectomy snare and other tools were unsuccessful because of the roundness and smoothness of the stone. Although we could chip away at the surface, we were unable to break the seal of the stone against the colon mucosa. We found the most effective method was tunneling through the stone’s centre using a closed rat-tooth forceps, then angling the tip of the scope and pulling the scope back to break off fragments from within. A polypectomy snare was used to further breakup larger fragments to prevent repeat impaction (1D). There was underlying diverticular disease and mild ischemic changes to the mucosa but no stricture. The patient did well post-procedure and was able to tolerate oral intake, pass flatus, and pass bowel movements. He was discharged 3 days later.A recent systematic review found a total of 38 cases of gallstone obstruction of the colon. Majority of patients (73.6%) ultimately required surgical intervention. Overall mortality is 13.1%.ConclusionsGallstone impaction in the colon is uncommon with successful endoscopic treatment seldomly described. This report describes a rare complication of gallstone disease that was successfully treated with widely available endoscopic tools. Funding AgenciesNone

A Case of Gallbladder Empyema Causing Cholecystoduodenal Fistula in a Diabetic Elderly Man

Introduction: Cholecystoduodenal fistula is a rare complication of cholelithiasis, occurring in less than 5% of cases. We present a case of gallbladder empyema and cholecystoduodenal fistula in an elderly man with diabetes. Case Illustration: A 70-year-old diabetic man was referred to the digestive surgery department on his second week of admission by the internist. He had come in with septic shock that was thought to be caused by pneumonia. He was admitted to the internal ward and treated with antibiotics. He was not showing any significant improvement when he started complaining right upper abdominal pain. He had had a history of right upper abdominal pain that comes and goes, and at one point had been diagnosed with gallstones. However, he had not had any surgeries for the gallstone disease. An abdominal CT-scan was obtained showing multiple gallbladder stone and gallbladder empyema that involved the duodenum causing a cholecystoduodenal fistula. We performed an open cholecystectomy and pyloric exclusion gastro-jejunostomy. The patient recovered well without any complication and was discharged by POD-7. Conclusion: Gallbladder empyema and cholecystoduodenal fistula is often hard to diagnose clinically since the signs and symptoms mimic those of a chronic cholecystitis. However, it should always be contemplated in elderly patients with comorbidities such as diabetes and heart disease.

Laparoscopic Treatment оf Mirizzi Syndrome

Background. Mirizzi syndrome (MS) is a relatively rare complication of cholelithiasis, which occurs in a wide range from 0.2 to 5% according to different authors. Today, the surgical treatment of MS remains a challenge.Aim of study. To determine the possibilities of laparoscopic interventions in the surgical correction of various types of MS.Material AND methods. The work is based on a prospective analysis of cases of laparoscopic treatment of 19 patients with MS who were treated in the emergency surgery departments of the Republican Scientific Center for Emergency Medical Care in 2017–2019. This is 22.9% of all admitted patients (83) with MS during this period. Type 1 MS was diagnosed in 3 patients (15.7%), type 2 was diagnosed in 16 patients (84.2%).Results. In all cases of type 1 MS, laparoscopic cholecystectomy was performed. A new method for the correction of type 2 MS by forming a sleeve from the gallbladder wall was suggested, which was performed in 10 patients with good results. In the postoperative period, no nonspecific complications were observed in patients undergoing laparoscopic interventions. One patient had residual choledocholithiasis, which was managed by day 5 after the surgery with endoscopic retrograde cholangiopancreatography and endoscopic papillosphincterotomy and the removal of the calculus from the common bile duct. The average duration of stay of patients in a hospital bed was 10.8 days. Fatal outcome was observed in 1 case (5.3%).Conclusion. 1. The inclusion of endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and magnetic resonance imaging cholangiography in the diagnostic scheme improves the accuracy and quality of recognition of Mirizzi syndrome and allows the indications for the use of video laparoscopy to be evaluated. 2. Indication for laparocopic treatment of type 2 Mirizzi syndrome is the presence of a single calculus in the supraduodenal part of the common bile duct, which makes it possible to reduce the number of conversion to laparotomy. 3. In cases of type 1 Mirizzi syndrome, the operation of choice is laparoscopic cholecystectomy. 4. The operation of choice in patients with type 2 Mirizzi syndrome is laparoscopic subtotal cholecystectomy, fistula plasty with a gallbladder flap on the Kehr’s T-tube drain with the formation of a “cystic duct”-type sleeve.

Cholecysto-pyloric fistula with submucosal impaction of gall stone causing gastric outlet obstruction masquerading as a gastric mass, Bouveret Syndrome: case report

BackgroundCholecysto-enteric fistula is a rare complication of cholelithiasis and cholecystitis. Another even rarer complication is proximal impaction of gallstone(s) in gastric pylorus leading to gastric outlet obstruction, known as the Bouveret Syndrome. Only a few cases have been reported in the available literature. It can be confused with a malignant thickening at the pylorus, knowledge of this syndrome helps in arriving at the right diagnosis.Case reportA 52-year-old female patient, who was admitted to our hospital for evaluation of recurrent vomiting and abdominal pain. She was investigated with various imaging modalities including upper gastrointestinal (GI) endoscopy, abdominal ultrasonography as well as Contrast Enhanced Computerized Tomography (CECT) scan of the abdomen. On the outside scan, it was given as a malignant thickening at the pylorus. However, current radiologists felt that imaging findings were not of a typical malignant mass, and suspicion of Bouveret syndrome was given. Intraoperative findings confirmed the diagnosis of Bouveret syndrome. The patient has not experienced any postoperative complications till now.ConclusionBouveret syndrome is associated with significant morbidity and mortality. Being familiar with the imaging appearance of this condition, and differentiating it with malignant thickening can help radiologists avoid unnecessary invasive procedures in such patients. Being a benign etiology, it also helps in a better prognosis.

Gallstone ileus associated with cholecystogastric fistula: Case report, diagnosis and surgical treatment.

IntroductionGallstone Ileus is a rare complication of cholelithiasis, associated with multiple episodes of cholecystitis, with the formation of adhesions and fistulas between the gallbladder and adjacent organs. Its diagnosis is difficult, requiring complementary imaging tests such as computed tomography or radiography.Presentation of caseFemale patient, with intestinal obstruction for 7 days, associated with abdominal pain and previous episodes of pain in the right hypochondrium for 3 months. Abdominal CT scan identified aerobilia, gallstone impacted in the ileocecal valve and small loop dilatation, in addition to a probable cholecystogastric fistula. Opted for exploratory laparotomy, enterolithotomy and fistula correction in one surgical time.DiscussionGallstone ileus is rare among the complications of cholelithiasis, in addition to the fact that cholecystogastric fistula is associated with gastric pylorus obstruction and not impaction on the ileocecal valve. Imaging tests are useful to complement the diagnosis, and if Rigler's triad is present, the suspicion of gallstone ileus is increased. The presence of fistula between the gallbladder and stomach presents a frequency between 0 and 13.3%. There is no gold standard treatment for gallstone ileus, but surgery options for each type of patient and severity level.ConclusionThere is no definitive protocol for optimal surgical treatment for biliary ileus, but the possibility of enterolithotomy associated with cholecystectomy and fistula correction can be evaluated in selected patients.

S1597 The Curious Case of a Missing Gallbladder: An Unusual Presentation of a Large Gallstone and Cholecystoduodenal Fistula

INTRODUCTION: Cholecystodudenal fistula is a rare complication of cholelithiasis. We present a unique endoscopically-treated case of a 5 cm gallstone that caused acute abdominal pain without gastric outlet obstruction in a middle-age female. CASE DESCRIPTION/METHODS: A 56-year-old woman with DM type II, hypertension, and BMI of 48 kg/m2 presented with acute right upper quadrant pain for 3 days. It was associated with nausea but no emesis, aggravating or alleviating factors. She had no prior abdominal surgeries. Vitals were normal. There was tenderness in the right upper quadrant but Murphy’s sign was negative. WBC, ALT, AST, total bilirubin and lipase were within normal limits. An ultrasound showed gallstones in a contracted gallbladder with no signs of cholecystitis. Robotic-assisted laparoscopic cholecystectomy was attempted, however, there was substantial amount of adhesions. Lysis of the adhesions was performed, then the duodenum and the stomach were found adhered to the gallbladder fossa. Thus, cholecystectomy was not deemed safe and the surgery was aborted. MRCP showed a minimal fluid collection in the gallbladder fossa but no evidence of bile duct stones or dilation. The gallbladder could not be identified. HIDA scan did not show it either. A CT scan of the abdomen revealed a cholecystoduodenal fistula along with air in a non-dilated biliary tree. EGD revealed a 5 cm golden-brown and hard stone and an inflamed and scarred fistulous opening in the bulb. The stone was too large to be retrieved through the pylorus. To prevent GI obstruction and to avoid a high-risk laparotomy, a large snare with a hard wire was used to break it down by forcefully pulling it against the plastic tip of the snare. The fragments were brought to the stomach for further fragmentation. The fragments were retrieved using stone baskets. Following the procedure, the symptoms improved. DISCUSSION: What was initially thought to be a classic case of symptomatic cholelithiasis was found to be a clinically, surgically, and endoscopically challenging cholecystoduodenal fistula. The fistula was not seen during an attempted cholecystectomy, nor was it seen on MRCP. Only CT then endoscopy revealed it. Large gallstones causing fistulas are very rare in the young. Laser, extracorporeal shockwave, and intracorporeal electrohydraulic lithotripsies have been used to treat large gallstones. Due to our limited resources, we performed mechanical fragmentation using the readily available stiff snares and stone baskets; a rarely reported approach.Figure 1.: Coronal oral and intravenous enhanced CT image of the abdomen demonstrates a large calculus (yellow arrow) with a few foci of air, as well as air within the biliary system (green arrow) suggesting choleduodenal fistula. A small amount of ascites surrounds the liver. There is also subcutaneous air within the right abdominal wall and adjacent to the gluteal muscles due to recent laparoscopy.Figure 2.: Endoscopic view of a large golden-brown, smooth and hard gallstone in the duodenal bulb. Erosion is seen on the wall of the duodenum.Figure 3.: Fragmentation of the large gallstone using a large-opening hard wire snare.

Rigler’s triad in a case of gallstone ileus

Background: gallstone ileus is a rare complication of cholelithiasis. It is defined as a mechanical obstruction of the small bowel due to impaction of large gallstones into the gastrointestinal tract, generally though a cholecystoduodenal fistula. Rigler’s triad (pneumobilia, ectopic gallstone and mechanical obstruction) occurs in 30% of the patients. Surgery is indicated and includes enterotomy with gallstone extraction. Objective: we report a case of gallstone ileus with radiographic evidence of Rigler’s triad

A Rare Case of Large Impacted Stone in Jejunum Causing Obstruction in a Patient of Gallstone Ileus

Gallstone ileus is a rare complication of cholelithiasis that occurs as a result of occlusion of the intestinal lumen by a large sized gallstone accounting for 1-4% cases of small bowel obstruction. The aim of this work is to introduce a case report that emphasize the diagnostic and therapeutic management of gallstone ileus with an enterolith impacted in jejunum (an uncommon site).

Ultrasonografski pregled abdomena kao dovoljan dijagnostički modalitet u postavljanju dijagnoze bilijarnog ileusa - prikaz slučaja

Introduction: Biliary ileus is a rare emergency condition that mainly affects the elderly population, with a predominance of females and a mortality rate of 12-27%. It is a mechanical intestinal obstruction caused by the impaction of the biliary calculus within the gastrointestinal tract. It occurs due to the formation of bilio-enteric fistula, as a rare complication of cholelithiasis. Case report: A 73-year-old male patient with epigastric pain, nausea and vomiting was referred for ultrasound exam. The analysis of the clinical-biochemical status of the patient as well as the ultrasound examination of the abdomen itself raised the suspicion of small intestine obstruction, due to the enclaved biliary calculus. After an urgent exploratory laparotomy, the diagnosis was confirmed, and enterotomy was successfully performed with calculus extraction. Cholecysto-duodenal fistula has been confirmed as a major cause of biliary ileus. The post-operative course was uneventful. Conclusion: This case report highlights the enormous importance of ultrasound diagnostics in diagnosing biliary ileus using the criteria of The Rigler Triad, which includes pneumobilia, intestinal obstruction and ectopic calculus. Initially unrecognised cause of obstruction and a late diagnosis correlated with bad prognosis. Ultrasonographic examination of these patients can be a sufficient diagnostic modality in making an accurate diagnosis and further surgical treatment of these patients

CLINICAL UTILITY OF RADIOLOGICAL IMAGING IN THE EVALUATION OF GALLSTONE ILEUS

Objective: Gallstone ileus is a rare complication of cholelithiasis. It occurs as a result of the passage of bile stones into intestinal system via bilioenteric fistulae, which are formed by recurrent attacks of cholecystitis, and obstruction of the intestinal lumen. The objective of our study was to discuss the imaging findings of gallstone ileus among patients diagnosed at our center.Material and Methods: Among patients that admitted to our hospital’s radiology department between December 2016 and January 2019, the medical records of those with a history of gall bladder stone detected on ultrasonography were retrospectively evaluated. Among those, cases of gallstone ileus were identified. Admission complaints, age, sex, comorbidities, radiological imaging findings, fistula localization, stone size, and obstruction level were recorded and analyzed.Results: Among 958 patients with bile stones, 342 (35.7%) were male and 616 (64.3%) were female. Gallstone ileus was identified in five patients. Three of them were female (mean age 76.67± 13.05 years) and 2 were male (mean age 59±1.41 years). Ileus signs were detected on plain radiograms for all patients. The gallbladders were not clearly visualized by ultrasonography in any of patients with gallstone ileus. A diameter increase suggestive of ileus was detected in visualizable intestinal segments. Computed tomography to identify the cause of ileus revealed air in the bile ducts, cholecystoduodenal fistula, stones in intestinal lumen, and an appearance consistent with ileus proximal to that segment. The mean size of the stones was 26.20±16.3 mm (16-55 mm).Conclusion: Although gallstone ileus is a rare cause of intestinal obstruction, it should be definitely remembered in the differential diagnosis in patients with advanced age and a history of cholelithiasis who present to the emergency department.