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Khurshid MH, Hejazi O, Spencer AL, Nelson A, Stewart C, Colosimo C, Ditillo M, Matthews MR, Magnotti LJ, Joseph B. A little goes a long way: A comparison of enterolithotomy versus single-stage cholecystectomy in the management of gallstone ileus. J Trauma Acute Care Surg 2025; 98:649-654. [PMID: 39621426 DOI: 10.1097/ta.0000000000004497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
INTRODUCTION Gallstone ileus is an infrequent complication of cholelithiasis with no specific guidelines for its management. This study aims to compare the outcomes of patients with gallstone ileus managed with both enterolithotomy with cholecystectomy (EL-CCY) versus those managed with enterolithotomy (EL) only. METHODS In this retrospective analysis of 2011-2017 Nationwide Readmissions Database, all patients with an index admission diagnosis of gallstone ileus were included. Patients were stratified based on the type of intervention received for gallstone ileus into those who underwent EL-CCY and those who underwent EL alone and compared. Primary outcomes were in-hospital complications (surgical site infections, sepsis, pneumonia, cardiac arrest, deep vein thrombosis, intestinal obstruction) and mortality. Secondary outcomes were hospital length of stay, hospital costs, and readmissions rate and cause of readmissions. Multivariable logistic regression analysis was performed. RESULTS A total of 1,960 patients were identified. The mean age was 67 years and 67% were female. Two hundred eighty-nine patients (14.7%) were managed with EL-CCY, whereas 1,671 patients (85.3%) underwent EL only. Overall, the readmission rate was 4.8%, whereas mortality was 4.2%. There was no significant difference between groups in terms of index-admission complications (24.8% vs. 21.7%, p = 0.415), mortality (6.2% vs. 3.9%, p = 0.068), rates of readmission (3.5% vs. 5.1%, p = 0.22), and cause of readmission ( p > 0.05). Enterolithotomy and cholecystectomy group had significantly longer hospital length of stay (10 vs. 8 days, p < 0.001) and median hospital costs ($70,959 vs. $52,147, p < 0.001). On multivariable logistic regression analysis, female sex was a predictor of undergoing EL-CCY, whereas increasing age and higher grade of all-patient redefined diagnosis-related groups risk of mortality were independently associated with lower odds of undergoing EL-CCY. CONCLUSION Our findings suggest no difference between EL compared with EL-CCY in terms of complications, readmissions, and mortality. However, patients managed with EL-CCY had a longer hospital stay and higher hospital costs compared with EL. Further prospective studies are needed to validate these findings and develop management protocols for gallstone ileus. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Muhammad Haris Khurshid
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
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Wu TS, Ng WC, Wu JM, Chen KH. Spontaneous remission of gallstone ileus. Asian J Surg 2024:S1015-9584(24)01409-X. [PMID: 38987152 DOI: 10.1016/j.asjsur.2024.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
- Ting-Shuan Wu
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Weng-Chong Ng
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jiann-Ming Wu
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Kuo-Hsin Chen
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Cadili L, Streith L, Segedi M, Hayashi AH. Management of complex acute biliary disease for the general surgeon: A narrative review. Am J Surg 2024; 231:46-54. [PMID: 36990834 DOI: 10.1016/j.amjsurg.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/26/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
Acute gallbladder diseases are a common surgical emergency faced by General Surgeons that can sometimes be quite challenging. These complex biliary diseases require multifaceted and expeditious care, optimized based on hospital facility and operating room (OR) resources and the expertise of the surgical team. Effective management of biliary emergencies requires two foundational principles: achieving source control while mitigating the risk of injury to the biliary tree and its blood supply. This review article highlights salient literature on seven complex biliary diseases: acute cholecystitis, cholangitis, Mirizzi syndrome, gallstone ileus with cholecystoenteric fistula, gallstone pancreatitis, gall bladder cancer, and post-cholecystectomy bile leak.
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Affiliation(s)
- Lina Cadili
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Lucas Streith
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maja Segedi
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; Hepatopancreatobiliary and Liver Transplant Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Allen H Hayashi
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; Division of General Surgery, Island Health Authority, Victoria, British Columbia, Canada
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Kularatna M, Falconer F. Double Trouble: A Case of Gallstone Ileus as a Result of Multiple Obstructive Gallstones. Case Rep Surg 2023; 2023:7423380. [PMID: 37927905 PMCID: PMC10624547 DOI: 10.1155/2023/7423380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/27/2023] [Accepted: 09/01/2023] [Indexed: 11/07/2023] Open
Abstract
Gallstone ileus is a rare condition. It accounts for approximately 1% of small bowel obstruction and is more prevalent in the elderly population. It is usually present in relatively comorbid patients posing further operative challenges. The following report investigates the management of two large gallstones resulting in two different points of obstruction. Is double trouble doubly hard to manage?
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Affiliation(s)
- Malsha Kularatna
- General Surgical Registrar Bay of Plenty District Health Board, 90 Pakanga Grove, Pyes Pa, Otago, New Zealand
| | - Fransiska Falconer
- General Surgical Registrar Tauranga Hospital, 66 Te Horo Drive, Ohope, New Zealand
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Pichardo J, Zapata J, Echavarría R, Ubiñas R, Báez P, Gómez Á. Gallstone Ileus With Cholecystoenteric Fistula in an Elderly Female: A Case Report. Cureus 2023; 15:e37077. [PMID: 37153256 PMCID: PMC10156418 DOI: 10.7759/cureus.37077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Mechanical small-bowel obstruction can occur due to various reasons, including the impaction of a gallstone in the ileum after it has passed through a cholecystoenteric fistula. Gallstone ileus is an infrequent yet significant cause of this condition. This case report documents an instance of gallstone ileus, which accounts for less than 1% of patients with mechanical small bowel obstruction. We report a 75-year-old female patient who presented with colicky pain in both upper quadrants, hyporexia, and constipation that worsened during a period of nine days, which subsequently was accompanied by nausea and vomiting of bilious appearance in the next three days. Abdominal CT reported a dilated common bile duct (1.7 cm) with multiple stones inside measuring between 5 and 8 mm associated with pneumobilia of intrahepatic bile ducts and dilatation of small intestinal loops produced by a high-density image of approximately 2.5 cm. Laparoscopic exploration showed an obstructive mass measuring 15 cm from the ileocecal valve corresponding to a 2.54 x 2.35 cm gallstone, which was removed and enterorrhaphy was performed. The sine qua non condition for gallstone ileus to occur is the presence of a fistula between the gallbladder and the gastrointestinal tract. The treatment is mainly surgical and should be aimed primarily at the intestinal obstruction and secondarily at the cholecystoenteric fistula. This condition tends to have a high rate of complications and consequently long hospital stays. Making a timely diagnosis provides us with the tools for a surgical approach aimed at intestinal obstruction and subsequently in the management of the biliary fistula.
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Santos SD, Louro J, Costa Almeida CM, Simões S, Fortuna J. Gallstone Ileus: A Rare Cause of Mechanical Bowel Obstruction. Cureus 2023; 15:e35588. [PMID: 37007418 PMCID: PMC10062434 DOI: 10.7759/cureus.35588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
A gallstone ileus is a rare cause of mechanical bowel obstruction, accounting for 1% to 4% of all cases. Twenty-five percent of the patients are 65 years of age or older and often present previous significant medical conditions. The authors report the case of an 87-year-old male patient, admitted with the diagnosis of community-acquired pneumonia, who later developed frequent episodes of biliary vomiting, intermittent constipation, and abdominal distension. Abdominal imaging (ultrasound and computed tomography (CT)) showed evidence of a localized inflammatory process in a small bowel loop but excluded vesicular lithiasis. After a failure in the medical approach with antibiotics, an exploratory laparotomy was performed, identifying the intestinal occlusion area, followed by an enterolithotomy at the specific area, and extraction of a 4 cm stone of acellular material. Posteriorly, the patient was treated for three weeks with a carbapenem and physical rehabilitation was promptly initiated with full recovery of his previous status. Gallstone ileus is a very challenging diagnosis and surgery is the treatment of choice. In elderly patients, it is important to promote prompt physical rehabilitation to prevent prolonged bed rest.
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Shrestha N, Mishra A, Ghimire R. An unusual case of subacute small bowel obstruction - Gallstone ileus. Int J Surg Case Rep 2022; 92:106820. [PMID: 35189458 PMCID: PMC8861133 DOI: 10.1016/j.ijscr.2022.106820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Gallstone ileus is caused by an impaction of one or more gallstones within the gastrointestinal tract, leading to mechanical intestinal obstruction. It is a rare complication of cholelithiasis leading to the formation of a cholecystoenteric fistula and is associated with high mortality rates. We report a case of atypical subacute small bowel obstruction due to gallstone ileus. Presentation of case An 82-year-old man, with previously diagnosed cholelithiasis, presented with abdominal pain and vomiting for nine days. The contracted gallbladder with distended bowel loops was visualized on abdominal ultrasound. Computed tomography of the abdomen and pelvis revealed dilated loops of the small intestine with a gallstone in the proximal ileum, causing intestinal obstruction with pneumobilia, suggesting gallstone ileus with cholecystoduodenal fistula. The patient underwent an emergency laparotomy and enterolithotomy to remove the impacting gallstone. The cholecystoduodenal fistula was left undisturbed due to the significant risk of duodenal injury. The patient had an uneventful postoperative recovery. Conclusion Gallstone ileus almost always requires surgical management. However, performing an interval biliary surgery is based on the clinical judgment of the surgeon. In our case, the patient's clinical status determined the treatment in which an enterotomy with stone extraction alone was largely sufficient, and has supported the literature. Gallstone ileus is an important differential diagnosis in elderly patients with gallstone disease, untreated or undiagnosed, presenting with features of small bowel obstruction.
Gallstone ileus is a rare cause of small bowel obstruction, commonly in the elderly. Cholelithiasis, untreated or undiagnosed, may result in a cholecystoduodenal fistula and gallstone ileus. CT scan is the preferred imaging modality and characteristic radiological findings aid in early diagnosis. An enterotomy with stone extraction is sufficient in comorbid patients without intruding on the cholecystoduodenal fistula.
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Affiliation(s)
- Nischal Shrestha
- Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | - Aakash Mishra
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
| | - Roshan Ghimire
- Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
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Gungor F, Atalay Y, Acar N, Gur EO, Kokulu I, Acar T, Karasu S, Dilek ON. Clinical outcome of gallstone ileus; a single-centre experience of case series and review of the literature. Acta Chir Belg 2022; 122:7-14. [PMID: 32857668 DOI: 10.1080/00015458.2020.1816673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Gallstone ileus (GI) is a rare entity which is seen in 0.5% of patients with cholelithiasis. In this study, we aimed to share our clinical approach to GI, to present our long-term results and to draw clinicians' attention to this rare entity. MATERIALS AND METHODS This study included 11 patients with GI whose medical records were evaluated retrospectively. RESULTS Majority of the 11 patients were female (63.7%, n:7) and the mean age was 71.9 ± 14.10 (range: 50-91). Most common presenting complaints were vomiting (n: 9) and abdominal pain (n: 9). The mean interval from the onset of symptoms to the hospital admission was 3.8 ± 0.75 (range 3-5) days. Rigler triad in abdominal computed tomography (CT) was detected in all cases. Enterolithotomy, one-step procedure and conservative treatment were performed in five (45.4%), four (36.3%) and two (18.1%) patients, respectively. Enterolithotomy group was found to have higher risk according to American Society of Anesthesiologists (ASA) classification, shorter operation time and less intraoperative blood loss. CONCLUSION Although enterolithotomy is the first choice for patients with GI, one-step procedure should be kept in mind as a more advantageous technique in low-risk patients.
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Affiliation(s)
- Feyyaz Gungor
- Department of General Surgery, Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey
| | - Yigit Atalay
- Department of General Surgery, Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey
| | - Nihan Acar
- Department of General Surgery, Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey
| | - Emine Ozlem Gur
- Department of General Surgery, Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey
| | - Ibrahim Kokulu
- Department of General Surgery, Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey
| | - Turan Acar
- Department of General Surgery, Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey
| | - Sebnem Karasu
- Department of Radiology, Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey
| | - Osman Nuri Dilek
- Department of General Surgery, Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey
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García-Quijada García J, Valle Rubio A, Pastor Riquelme P, Serantes Gómez A. Case report: Closed-loop bowel obstruction secondary to a double gallstone ileus. Int J Surg Case Rep 2021; 89:106612. [PMID: 34823163 PMCID: PMC8627953 DOI: 10.1016/j.ijscr.2021.106612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/30/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance In this paper, we report an unusual case of a closed-loop bowel obstruction secondary to a double gallstone ileus. This type of pathology constitutes an emergency, and requires prompt surgical intervention to prevent further complications. Presentation of case The patient was a 90-year-old female who came to our emergency room with a clinical picture compatible with an acute abdomen. Imaging tests performed included a plain radiograph and abdominal CT-scan, which confirmed the diagnosis. The patient was then transferred to the operating room, and an open double enterolithotomy was performed, extracting two cylindrical gallstones with a diameter of over 2.5 cm. No treatment was given for either the gallbladder nor the biliary-enteric fistula due to the patient's physical status. Clinical discussion Gallstone ileus is a rare entity, but must be taken into consideration when a patient with an abdominal obstruction arrives to the emergency department, especially when signs such as pneumobilia or visualization of the stones are detected by imaging tests. Early surgical intervention is required to avoid complications. However, addressing the biliary-enteric fistula at the same time is a sensitive procedure that may not be advisable, depending on the status of the patient. This report includes a bibliographic review of existing cases of gallstone ileus and the specifics of its diagnosis and management. Conclusion This pathology can lead to serious complications if not managed properly. Prompt diagnosis and surgical intervention are essential to avoid complications such as intestinal gangrene and perforation. Inspecting the entire intestine during surgery is crucial for removing any additional gallstones that may be present to prevent the reappearance of symptoms.
Gallstone ileus is an uncommon condition which requires an emergency surgical approach. The entire intestine should be inspected during surgery. A prompt diagnosis can be achieved via CT-scan. Management of gallbladder and biliary-enteric fistula is controversial. Enterolithotomy is the procedure of choice for relieving intestinal obstruction.
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Affiliation(s)
| | - Ainhoa Valle Rubio
- Hospital Universitario de Getafe, Madrid, Carretera Madrid-Toledo km 12.5, 28905, Spain
| | - Pablo Pastor Riquelme
- Hospital Universitario de Getafe, Madrid, Carretera Madrid-Toledo km 12.5, 28905, Spain
| | - Ana Serantes Gómez
- Hospital Universitario de Getafe, Madrid, Carretera Madrid-Toledo km 12.5, 28905, Spain
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Li M, Behrenbruch C, Jain A, Steven M, Wong A. Cholecystocolonic fistula resulting in large bowel obstruction due to gallstone. ANZ J Surg 2021; 91:E729-E730. [PMID: 33769669 DOI: 10.1111/ans.16791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Mo Li
- Colorectal Surgical Department, Box Hill Hospital, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Corina Behrenbruch
- Colorectal Surgical Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Anshini Jain
- Colorectal Surgical Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Mark Steven
- Upper GI surgical Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Alex Wong
- Colorectal Surgical Department, Box Hill Hospital, Melbourne, Victoria, Australia
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Campioni-Norman D, Faulkner J, Kumar L, Day A. A rare case report of an ilio-psoas abscess due to entero-retroperitoneal fistula from gallstones post cholecystectomy. Int J Surg Case Rep 2021; 79:402-404. [PMID: 33517213 PMCID: PMC7848702 DOI: 10.1016/j.ijscr.2021.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 02/07/2023] Open
Abstract
Ilio-psoas abscess due to gallstone entero-retroperitoneal fistulation post-cholecystectomy has not been reported previously. De-novo stone formation in the CBD can occur post-cholecystectomy and can lead to complications. Surgeons should consider gallstones as a differential in small bowel fistulation. Introduction and importance This is a novel case of a 50-year-old female presenting with several months of left iliac fossa pain, on a background of a cholecystectomy 5 years prior. The aetiology of her pain was an ilio-psoas abscess secondary to an entero-retroperitoneal gallstone fistula, a condition not previously reported in the literature. Case presentation CT imaging revealed an abscess superior to the left psoas muscle, with a clear fistula to the small bowel and two calcified stones at the site of the fistula. The patient was managed operatively, with the fistula disconnected and a 5 cm section of small bowel disconnected. Clinical discussion This is a novel case whereby a left sided iliopsoas abscess occurred due to entero-retroperitoneal fistulation of gallstones several years after the patient underwent laparoscopic cholecystectomy. Gallstone fistulation from within the small bowel does not appear to have previously been documented and the exact pathogenesis is unknown. Conclusion Gallstones should remain an important, albeit rare, differential diagnosis of small bowel fistulation and abscess formation following cholecystectomy.
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Affiliation(s)
| | - Jack Faulkner
- Ashford and St Peters Hospital, Surgery, United Kingdom
| | - Lalit Kumar
- Ashford and St Peters Hospital, Surgery, United Kingdom
| | - Andrew Day
- Ashford and St Peters Hospital, Surgery, United Kingdom
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Affiliation(s)
- M. La Meir
- Department of Abdominal Surgery, O.L.V. Ziekenhuis, Aalst, Belgium
| | - Y. Van Molhem
- Department of Abdominal Surgery, O.L.V. Ziekenhuis, Aalst, Belgium
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Ramrakhiani H, Simpson N, Strichartz SD, Shetler K, Triadafilopoulos G. Like a "Rolling" Gallstone: Cholecystoduodenal Fistula as Evidence of Gallstone Ileus. Dig Dis Sci 2020; 65:2518-2520. [PMID: 31989397 DOI: 10.1007/s10620-020-06088-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abstract
Gallstone ileus is an unusual complication of cholelithiasis. Classically, a stone is impacted at the terminal ileum originating from a cholecystoduodenal fistula. Exceptions to this pathophysiology have been noted at each step. In this systematic review, we document a comprehensive review of postcholecystectomy gallstone ileus inclusive of 49 separate cases and report 8 different mechanisms leading to this unusual complication. The most common mechanism is a lost stone during cholecystectomy that then erodes through the intestinal wall leading to bowel obstruction. Our review showed an older, female predominance (64.0%) at an average age of 68.0 years, patients typically had a burden of comorbidities. Delay in diagnosis was common (64% of cases) with the correct diagnosis made in 37.5% of patients during admission. Pneumobilia was commonly reported (29.0%). There was a wide range in the amount of time between cholecystectomy and gallstone ileus, from 10 days to 50 years (mean 12.4 years). Postcholecystectomy gallstone ileus is an unusual complication of cholelithiasis, which mandates surgery. Retrieval of stones should be undertaken if they are spilled during cholecystectomy. Owing to the increasing age of the American patient population, it is likely that a higher number of patients with this condition will be encountered.
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Affiliation(s)
- Jennie Meier
- 20115 Department of Surgery, VA North Texas Health Care System, Dallas, TX, USA.,12334 Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Angela A Guzzetta
- 20115 Department of Surgery, VA North Texas Health Care System, Dallas, TX, USA
| | - Sergio Huerta
- 20115 Department of Surgery, VA North Texas Health Care System, Dallas, TX, USA
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Robustelli V, Fedi M, Riccadonna S, Giannessi S. Fistola bilio-digestiva e ileo biliare: descrizione di un caso clinico. Chirurgia (Bucur) 2020; 33. [DOI: 10.23736/s0394-9508.19.04966-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Rabie MA, Sokker A. Cholecystolithotomy, a new approach to reduce recurrent gallstone ileus. Acute Med Surg 2019; 6:95-100. [PMID: 30976433 PMCID: PMC6442528 DOI: 10.1002/ams2.404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/06/2019] [Indexed: 12/11/2022] Open
Abstract
The incidence of gallstone ileus (GSI) is increasing. Current treatment options include enterolithotomy with or without cholecystectomy and repair of the biliodigestive fistula. Although most surgeons defer the management of the biliodigestive fistula to avoid the associated morbidity and mortality, this can lead to increased rate of recurrence of GSI by the remaining gallstones. More than 130 cases of recurrent GSI were reported in published works, and the incidence of recurrent GSI is reported to be between 5% and 20%. Some cases of second recurrent attacks have also been reported. Most cases were reported in elderly women with faceted stones during the first 2 months from the first episode of GSI. This article reviews the current treatment options for more than 4,300 reported cases of GSI. A treatment algorithm is recommended based on the severity of the inflammation around the gallbladder, including cholecystolithotomy as a third treatment approach that aims to reduce the risk of recurrent GSI.
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Affiliation(s)
- Mohamed A. Rabie
- General SurgeryThe Queen Elizabeth Hospital in Kings LynnKings LynnUK
- General SurgeryAin Shams University HospitalCairoEgypt
| | - Ashraf Sokker
- General SurgeryThe Queen Elizabeth Hospital in Kings LynnKings LynnUK
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Loh WL, Ng NZP, Kabir T, Chan CY. Rare case of gallbladder mucocele causing gastric outlet obstruction treated with cholecystectomy. Int J Surg Case Rep 2019; 57:84-87. [PMID: 30925449 PMCID: PMC6439269 DOI: 10.1016/j.ijscr.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/26/2019] [Accepted: 03/10/2019] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Gallstone(s) impacted at the distal small bowel causing intestinal obstruction as a result of cholecystoenteric fistula is a well-known, albeit uncommon surgical condition. The rare Bouveret's Syndrome, which refers to the proximal impaction of gallstone(s) in the duodenum or pylorus resulting in the gastric outlet obstruction (GOO), has also been described in the literature. However, gallbladder mucocele with extrinsic compression of the duodenum and/or pylorus causing GOO is a separate entity that is extremely rare. PRESENTATION OF CASE A patient who presented with loss of appetite and weight, with intermittent vomiting over a course of eight months was found to have GOO secondary to extrinsic duodenal compression from a large gallbladder mucocele. Surgical intervention in the form of cholecystectomy was performed, and the patient's symptoms resolved post-operatively. DISCUSSION We describe an extremely rare case of GOO, which can be easily corrected with cholecystectomy. Removal of the gallbladder removes the root cause of the issue, and should be first line therapy unless the patient is unfit for surgery. CONCLUSION This extremely rare cause of GOO should be recognized, and treated promptly with surgery if possible.
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Affiliation(s)
- Wei-Liang Loh
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Academia Level 5, 20 College Road, Singapore, 169856, Singapore.
| | - Nick Zhi Peng Ng
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Academia Level 5, 20 College Road, Singapore, 169856, Singapore.
| | - Tousif Kabir
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Academia Level 5, 20 College Road, Singapore, 169856, Singapore.
| | - Chung Yip Chan
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Academia Level 5, 20 College Road, Singapore, 169856, Singapore.
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Mazine K, Barsotti P, Elbouhaddouti H, Taleb KA. [Colonic gallstone ileus: a rare cause of colonic obstruction]. Pan Afr Med J 2017; 27:187. [PMID: 28904712 PMCID: PMC5579432 DOI: 10.11604/pamj.2017.27.187.12238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 03/29/2017] [Indexed: 11/11/2022] Open
Abstract
Bile ileus with migration of the gallstone into the colon through cholecystocolonic fistula is rare. The diagnosis is difficult and often late. We here report the case of a 89-year old patient with a history of sigmoid diverticular disease presenting with colonic obstruction associated with bile ileus caused by migration of a large gallstone through cholecystocolonic fistula. Abdominal CT scan allowed the diagnosis. The patient underwent surgical extraction of the gallstone with sigmoidotomy followed by sigmoidostomy with subsequent recovery of the digestive continuity. The cholecystocolonic fistula wasn't identified.
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Affiliation(s)
- Khalid Mazine
- Service de Chirurgie Viscérale A (C3), CHU Hassan II Fès, Maroc
| | - Pierre Barsotti
- Service de Chirurgie Générale Digestive et Endocrine, Hôpital Emile Müller GHR Mulhouse, France
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19
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Tartaglia D, Bakkar S, Piccini L, Bronzoni J, Cobuccio L, Bertolucci A, Galatioto C, Chiarugi M. Less is more: an outcome assessment of patients operated for gallstone ileus without fistula treatment. Int J Surg Case Rep 2017; 38:78-82. [PMID: 28743097 PMCID: PMC5524312 DOI: 10.1016/j.ijscr.2017.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 12/12/2022] Open
Abstract
In this study, 1.9% patients were diagnosed with gallstone ileus among those admitted for small bowel obstruction. 85% of them underwent a conservative surgical approach mainly consisting in the enterolithotomy. Only one complication exceeded grade II in each group and no deaths were reported. Mean follow-up was 50 months and only one patient without fistula treatment had recurrent disease; no gallbladder cancer were identified. Enterolithotomy without fistula closure proved to be safe and effective for the management of gallstone ileus both on a short and long-term basis. Background The treatment of gallstone ileus (GI) consists of surgical removal of the impacted bilestone with or without cholecystectomy and repair of the biliodigestive fistula. The objective of this study was to assess whether sparing patients a definitive biliary procedure adversely influenced the outcome. Materials and methods Patients with a diagnosis of GI were reviewed. Two groups were identified: patients who underwent a definitive biliary procedure with relieving the intestinal obstruction (group 1/G1) and those who did not have a definitive biliary procedure (group 2/G2). In G2, patients were evaluated on long-term follow-up for the risk of recurrent GI disease, cholecystitis, cholangitis and gallbladder cancer. Results Among 1075 patients admitted for small bowel obstruction, 20 (1.9%) were diagnosed with gallstone ileus. 3 (15%) of these belong to G1, 17 (85%) to G2. The overall postoperative morbidity rate was 35% (7/20) with one complication exceeding grade II in each group. No deaths were reported. Mean follow-up was 50 months. During follow-up, one of G2 patients had recurrent disease. No biliary tract infections or gallbladder cancer were identified. Conclusion Enterolithotomy without fistula closure is confirmed to be safe and effective for the management of gallstone ileus both on a short- and long-term basis.
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Affiliation(s)
| | - Sohail Bakkar
- Division of Endocrine Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy; Faculty of Medicine, Department of Surgery, Hashemite University, Zarqa, Jordan
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Goldfinch AI, Prowse SJ. Gallstone ileus from a non-calcified stone: a challenging diagnosis. BJR Case Rep 2017; 3:20170038. [PMID: 30363202 PMCID: PMC6159182 DOI: 10.1259/bjrcr.20170038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/28/2017] [Accepted: 04/26/2017] [Indexed: 11/29/2022] Open
Abstract
Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case, we discuss a difficult diagnostic case of gallstone ileus with a non-calcified gallstone. An 88-year-old female presented with abdominal pain and vomiting. A CT scan was arranged and showed an evolving bowel obstruction although no frank hyperdensity suggestive of a gallstone was noted. Initially the cause of the bowel obstruction was uncertain, but after discussion with the treating team and further review of the images, the patient was diagnosed with gallstone ileus. The patient underwent emergency surgery and a 41 mm obstructing calculus was removed from the patient's jejunum, later confirmed on histological diagnosis.
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Affiliation(s)
| | - Simon John Prowse
- Department of Radiology, Lyell McEwin Hospital, Elizabeth Vale, Australia
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21
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Banu P, Constantin VD, Popa F, Nistor MF, Motofei IG, Bălălău C. Gallstone ileus - the double challenge: case report and review of the literature. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2016. [DOI: 10.25083/2559.5555.11.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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22
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Miyasaka T, Yoshida H, Makino H, Watanabe M, Uchida E, Uchida E. Response of gallstone ileus to conservative therapy. J NIPPON MED SCH 2015; 81:388-91. [PMID: 25744483 DOI: 10.1272/jnms.81.388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report a case of cholelithiasis followed by gallstone ileus, documented with serial computed tomography (CT) scans, that responded to conservative therapy. An 80-year-old woman was admitted because of abdominal pain and vomiting. Six months previously, she had presented with abdominal pain and nausea of sudden onset. A CT scan showed thickening of the gallbladder wall and a gallbladder stone. She refused cholecystectomy, and the abdominal pain gradually improved in response to conservative treatment. On admission, plain abdominal radiographs showed obstruction of the proximal small bowel. A CT scan revealed disappearance of the gallbladder stone, fluid-filled bowel loops, and the presence in the small bowel of an impacted stone (major axis, 45 mm; minor axis, 23 mm). We diagnosed gallstone ileus. Because the gallstone was not large, we inserted a stomach tube and administered conservative treatment. One day after admission, CT showed that the impacted stone had migrated to the transverse colon. Four days after admission the impacted stone was not seen on plain abdominal radiography. Five days after admission, follow-up CT revealed pneumobilia but no impacted stone. Because the symptoms had improved the patient resumed oral intake of liquids The patient was discharged 14 days after admission and is doing well.
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23
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Mir SA, Hussain Z, Davey CA, Miller GV, Chintapatla S. Management and outcome of recurrent gallstone ileus: A systematic review. World J Gastrointest Surg 2015; 7:152-9. [PMID: 26328035 PMCID: PMC4550842 DOI: 10.4240/wjgs.v7.i8.152] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/03/2015] [Accepted: 06/18/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To help the surgeon in decision making when treating a patient with recurrent gallstone ileus (RGSI). METHODS A systematic review related to RGSI was performed using the databases CINAHL, EMBASE, MEDLINE via PubMed from May 1912 to April 2015. All languages were included and the grey literature was also searched. The abstracts were explored for relevance to the topic and full texts obtained as appropriate. A manual search was carried out by scrutinising the reference lists of all the full text articles and further articles were identified and obtained. Total of 903 articles were identified, 656 were excluded after abstract review, 247 full text articles were reviewed and 91 articles selected for final analysis. There were 113 cases of RGSI. RESULTS There were 113 cases of RGSI reported in 91 articles. The majority of the recurrences, 62.6%, occurred within 6 wk of the index event. The male to female ratio was 1:7. The mean age was 69.6 years (SD 11.2) with a range of 38-95 years. The small bowel was the commonest site of impaction (92.2%). Treatment data was available for 104 patients. The two main operations performed were: (1) Enterolithotomy without repair of biliary fistula in 70.1% of all patients with a procedural mortality rate of 16.4% (12/73) and (2) a single stage surgery approach involving enterolithotomy with cholecystectomy and repair of the biliary enteric fistula in 16.3% with a procedural mortality of 11.7% (2/17). A subset analysis over last 25 years showed mortality from eneterolithotomy was 4.8% while single stage mortality was 22.2%. Enterolithotomy alone was the commonest operation performed for RGSI with four patients (5.4%) having a further recurrence of gallstone ileus. CONCLUSION Enterolithotomy alone or followed by a delayed two-stage treatment approach is the preferred choice offering low mortality and reduced risk of recurrence.
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Gandamihardja TAK, Kibria SMG. Recurrent gallstone ileus: beware of the faceted stone. BMJ Case Rep 2014; 2014:bcr-2014-205795. [PMID: 25391822 DOI: 10.1136/bcr-2014-205795] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A 73-year-old man with gallstone disease was admitted with right upper quadrant abdominal pain. He was treated for cholecystitis with intravenous antibiotics. Two days later, he reported of new onset left iliac fossa pain, with tenderness and guarding. An abdominal X-ray demonstrated small bowel obstruction, a CT scan demonstrated an impacted gallstone within the proximal ileum. He was treated for a gallstone ileum and underwent an uncomplicated laparotomy, small bowel enterotomy and removal of a faceted gallstone. Three months later, the patient re-presented with generalised abdominal pain, guarding and rebound tenderness. Small bowel obstruction was again demonstrated with an impacted gallstone within the distal ileum seen on CT scan. A second laparotomy revealed two further faceted gallstones, which were removed through an enterotomy. The densely adherent gallbladder to the duodenum precluded a surgical repair of the cholecystoduodenal fistula. He made an uneventful recovery and was subsequently discharged home.
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Affiliation(s)
| | - Shah M G Kibria
- Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
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25
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Abstract
Gallstone ileus is a rare complication of cholelithiasis accounting for 1-4% of cases of intestinal obstruction with a predominance in the elderly population. Unfortunately, it has an insipid presentation and is associated with significant rates of morbidity and mortality. Controversy arises over the management of gallstone ileus, and while surgery remains the mainstay of treatment, the main point of contention surrounds the extent of surgery. We describe the case of an 85-year-old woman who presented with symptoms and signs of large bowel obstruction. Radiological evaluation revealed a 5 cm×3.5 cm gallstone impacted in the sigmoid colon. A laparoscopic-assisted enterolithotomy alone relieved the obstruction with minimal surgical insult and allowed for a swift and uneventful recovery. Our case emphasises the need for a high index of suspicion for the condition as well as highlighting the advantages of the use of laparoscopic surgery in an emergency setting.
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Affiliation(s)
- Roisin Mary Heaney
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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26
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de Alencastro MC, Cardoso KT, Mendes CA, Boteon YL, de Carvalho RB, Fraga GP. Acute intestinal obstruction due to gallstone ileus. Rev Col Bras Cir 2014; 40:275-80. [PMID: 24173476 DOI: 10.1590/s0100-69912013000400004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/18/2012] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To perform a systematic review of the history, available image exams and clinical approach to the diagnosis and treatment of gallstone ileus. METHOD Retrospective study in a university hospital including all cases of SBO treated over a period of 23 years. According to the surgical treatment the patients were divided into two groups: (1) enterolithotomy with cholecystectomy performed later (two-stage surgery); and (2) enterolithotomy, cholecystectomy and fistula closure (one-stage surgery). RESULTS Twelve patients were included in the study, including 11 females (91,6%), with a mean age of 72.2 years. All patients presented associated diseases, mainly arterial hypertension (75%). All except one patient had multiple SBO symptoms. Gallstone ileus diagnosis was achieved in six patients (50%) before laparotomy. There were 8 patients in group 1 and 4 in group 2, and the morbidity was, respectively, 33.3% and 8.3%. Overall mortality was 16.6% (one patient in each group). CONCLUSIONS Gallstone ileus should be suspected in the elderly with SBO symptoms. Early diagnosis can reduce post-operative complications. Treatment is urgent laparotomy, and surgical treatment must be individualized for each case. The majority of patients in this study were treated with enterolithotomy, with cholecystectomy being performed later in two symptomatic patients.
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27
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Watanabe Y, Takemoto J, Miyatake E, Kawata J, Ohzono K, Suzuki H, Inoue M, Ishimitsu T, Yoshida J, Shinohara M, Nakahara C. Single-incision laparoscopic surgery for gallstone ileus: An alternative surgical procedure. Int J Surg Case Rep 2014; 5:365-9. [PMID: 24858981 PMCID: PMC4064429 DOI: 10.1016/j.ijscr.2014.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/16/2014] [Accepted: 04/21/2014] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Gallstone ileus (GI) results from the passage of a stone through a cholecystoenteric fistula, subsequently causing a bowel obstruction. The ideal treatment procedure for GI remains controversial. PRESENTATION OF CASE A 63-year-old female was admitted to our hospital following persistent nausea and vomiting for 7 days. Computed tomography revealed a partially calcified 4-cm circular object in the jejunum, and the proximal intestine was dilated, with concomitant pneumobilia. Based on the preoperative diagnosis of GI, enterotomy with stone extraction by single-incision laparoscopic surgery (SILS) was performed. The patient's postoperative course was uneventful, and the cholecystoduodenal fistula closed spontaneously 4 months after the surgery. DISCUSSION Recent studies have reported that enterotomy with stone extraction alone is associated with better outcomes than with more invasive techniques. This case also suggests that enterotomy with stone extraction alone and careful postoperative follow-up is feasible for the management of GI. Although the use of laparoscopy in the management of GI has been described previously, laparoscopic surgery has not been widely performed, and SILS is not generally performed. When only this less demanding procedure is required, laparoscopic surgery, including SILS, can be a viable option. CONCLUSION SILS can be an alternative surgical procedure for the management of GI.
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Affiliation(s)
- Yusuke Watanabe
- Department of Emergency Medicine, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan.
| | - Junkichi Takemoto
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan
| | - Eiji Miyatake
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan
| | - Jun Kawata
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan
| | - Keigo Ohzono
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan
| | - Hiroyuki Suzuki
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan
| | - Masaaki Inoue
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan
| | - Toshiyuki Ishimitsu
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan
| | - Junichi Yoshida
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan
| | - Masahiro Shinohara
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan
| | - Chihiro Nakahara
- Department of Emergency Medicine, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, Yamaguchi, Japan
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Abstract
INTRODUCTION Gallstone ileus is a mechanical bowel obstruction caused by a biliary calculus originating from a bilioenteric fistula. Because of the limited number of reported cases, the optimal surgical method of treatment has been the subject of ongoing debate. METHODS A retrospective review of the Nationwide Inpatient Sample from 2004 to 2009 was performed for gallstone ileus cases treated surgically by enterotomy with stone extraction alone (ES), enterotomy and cholecystectomy with fistula closure (EF), bowel resection alone (BR), and bowel resection with fistula closure (BF). Patient demographics, hospital factors, comorbidities, and postoperative outcomes were reported. Multivariate analysis was performed comparing mortality, morbidity, length of stay, and total cost for the different procedure types. RESULTS Of the estimated 3,452,536 cases of mechanical bowel obstruction from 2004 to 2009, 3268 (0.095%) were due to gallstone ileus-an incidence lower than previously reported. The majority of patients were elderly women (>70%). ES was the most commonly performed procedure (62% of patients) followed by EF (19% of cases). In 19%, a bowel resection was required. The most common complication was acute renal failure (30.44% of cases). In-hospital mortality was 6.67%. On multivariate analysis, EF and BR were independently associated with higher mortality than ES [(odds ratio [OR] = 2.86; confidence interval [CI]: 1.16-7.07) and (OR = 2.96; CI: 1.26-6.96) respectively]. BR was also associated with a higher complication rate, OR = 1.98 (CI: 1.13-3.46). CONCLUSIONS Gallstone ileus is a rare surgical disease affecting mainly the elderly female population. Mortality rates appear to be lower than previously reported in the literature. Enterotomy with stone extraction alone appears to be associated with better outcomes than more invasive techniques.
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Wong CS, Crotty JM, Naqvi SA. Pneumobilia: a case report and literature review on its surgical approaches. J Surg Tech Case Rep 2014; 5:27-31. [PMID: 24470847 PMCID: PMC3889000 DOI: 10.4103/2006-8808.118616] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Gallstones ileus is an uncommon cause but important cause of small bowel obstruction. The gallstone enters the intestinal lumen via a fistula located in the duodenum (cholecystoduodenal), or rarely, in the colon (cholecystocolonic) or stomach (cholecystogastric). This may result in large bowel or gastric outlet obstruction (Bouveret's Syndrome). Gallstone ileus affects the elderly females pre-dominantly and is associated with a high morbidity and mortality rate if diagnosis and urgent surgical intervention are delayed. In this paper, we report on the case of an elderly lady who presented with classical symptoms and signs of small bowel obstruction. She was subsequently diagnosed with gallstone ileus due to a large gallstones lodged in the intestinal lumen. We perform a literature review on this rare disease and discuss the two main surgical approaches in managing this condition. Gallstone ileus should be considered in the differential diagnosis of small bowel obstruction especially in elderly women who have no history of abdominal surgery or abdominal hernia. Early intervention is important because of the high mortality rate due to the poor general condition that often exists in this subgroup of patients. There is no general consensus on gold standard surgical approach in these cases but a two-stage procedure (either enterotomy alone or enterotomy and subsequent cholecystectomy) has been shown to be associated with lower mortality rates.
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Affiliation(s)
| | - James Maurice Crotty
- Department of Radiology, Limerick University Hospital, Limerick, Co. Limerick, Ireland
| | - Syed Altaf Naqvi
- Department of Surgery, Limerick University Hospital, Limerick, Co. Limerick, Ireland
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30
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Abstract
Gallstone ileus is an uncommon complication of cholelithiasis, usually associated with an internal biliary fistula. Management of gallstone ileus is surgical with enterolithotomy the procedure of choice, followed by fistula closure either as a one or two stage procedure. In this case a 66 year old female presented with colicky abdominal pain, computed tomography (CT) clearly showing a gallstone ileus and cholecystoduodenal fistula. Despite this the patient refused surgery and went on to have spontaneous resolution of the obstruction and passage of gallstones.
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Affiliation(s)
- Ja Roberts
- Redcliffe Hospital, Redcliffe, Queensland, Austrailia
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31
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Shin KH, Kim DU, Choi MG, Kim WJ, Ryu DY, Lee BE, Kim GH, Song GA. [A case of gallstone ileus treated with electrohydraulic lithotripsy guided by colonoscopy]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 57:125-8. [PMID: 21350324 DOI: 10.4166/kjg.2011.57.2.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstructive bowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient's known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals.
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Affiliation(s)
- Kyung Hwa Shin
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
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32
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Kim YG, Byeon JS, Lee SK, Yang DH, Kim KJ, Ye BD, Myung SJ, Yang SK, Kim JH. Gallstone ileus successfully treated with endoscopic fragmentation by using double-balloon endoscopy (with video). Gastrointest Endosc 2011; 74:228-30. [PMID: 21704821 DOI: 10.1016/j.gie.2010.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 12/13/2010] [Indexed: 12/11/2022]
Affiliation(s)
- Yong Gil Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Heinzow HS, Meister T, Wessling J, Domschke W, Ullerich H. Ileal gallstone obstruction: Single-balloon enteroscopic removal. World J Gastrointest Endosc 2010; 2:321-4. [PMID: 21160765 PMCID: PMC2999031 DOI: 10.4253/wjge.v2.i9.321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 06/30/2010] [Accepted: 07/07/2010] [Indexed: 02/05/2023] Open
Abstract
Gallstone-induced ileus is a rare complication of cholelithiasis. Since localization of gallstones impacted in the small bowel, especially in the ileum, prevents access by conventional endoscopy in most cases, the mainstay of treatment remains surgical. Recent invention of double- and single-balloon enteroscopy has added much to the ability of imaging the small bowel and enables endoscopically directed therapy. Herein, for the first time, we report a successful endoscopic calculus removal via peroral single-balloon enteroscopy in an 81-year-old woman suffering from gallstone ileus of the ileum.
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Affiliation(s)
- Hauke Sebastian Heinzow
- Hauke Sebastian Heinzow, Tobias Meister, Wolfram Domschke, Hansjoerg Ullerich, Department of Medicine B, University of Muenster, Muenster D48149, Germany
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34
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Fejes R, Kurucsai G, Székely A, Luka F, Altorjay A, Madácsy L. Gallstone Ileus, Bouveret's Syndrome and Choledocholithiasis in a Patient with Billroth II Gastrectomy - A Case Report of Combined Endoscopic and Surgical Therapy. Case Rep Gastroenterol 2010; 4:71-78. [PMID: 21103231 PMCID: PMC2988901 DOI: 10.1159/000208993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Intestinal obstruction due to gallstone is a rare, but quite severe gastrointestinal disorder, which always requires a rapid and correct diagnosis to achieve optimal therapy. Digestive endoscopy is an important method to determine the level of the bowel obstruction and to plan an optimal therapeutic strategy. Our present case demonstrates that in a high-risk patient, a combined endoscopic and surgical therapy is the best choice to solve the obstruction of the colon, of the stomach and of the common bile duct caused by multiple gallstones.
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Affiliation(s)
- R Fejes
- 1st Department of Gastroenterology, Szent György Hospital, Székesfehérvár, Hungary
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35
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Abstract
Gallstone ileus is a rare etiology of small bowel obstruction, occurring typically in the elderly population. The delay in diagnosis often results in significant morbidity and mortality. Here, we describe a case of 67 year old woman who presented with non specific abdominal symptoms and on evaluation was found to have small bowel obstruction caused by wedging of a large gallstone at the terminal ileum.
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Affiliation(s)
- Akshra Verma
- Department of Internal Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA.
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36
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Papavramidis TS, Potsi S, Paramythiotis D, Michalopoulos A, Papadopoulos VN, Douros V, Pantoleon A, Foutzila-Kalogera A, Ekonomou I, Harlaftis N. Gallstone obstructive ileus 3 years post-cholecystectomy to a patient with an old ileoileal anastomosis. J Korean Med Sci 2009; 24:1216-9. [PMID: 19949687 PMCID: PMC2775879 DOI: 10.3346/jkms.2009.24.6.1216] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 06/22/2008] [Indexed: 12/25/2022] Open
Abstract
The present case is one of gallstone obstructive ileus due to gallstones 3 yr after laparoscopic cholecystectomy. It is interesting because of the sex of the patient, the fact that ileus occurred 3 yr after cholecystectomy and that the localization of the obstruction was an old side-to-side ileoileal anastomosis due to a diverticulectomy following intussusception of Meckels' diverticulum at the age of 3.
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Affiliation(s)
- T S Papavramidis
- 1st Propedeutic Surgical Clinic, Aristotle University of Thessaloniki, A.H.E.P.A. University Hospital, Thessaloniki, Greece.
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Fitzgerald JEF, Fitzgerald LA, Maxwell-Armstrong CA, Brooks AJ. Recurrent gallstone ileus: time to change our surgery? J Dig Dis 2009; 10:149-51. [PMID: 19426399 DOI: 10.1111/j.1751-2980.2009.00378.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- J Edward F Fitzgerald
- Department of Gastrointestinal Surgery, University of Nottingham Medical School, Nottingham University Hospital, Nottingham, UK.
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Cholecystocolonic fistula: facts and myths. A review of the 231 published cases. ACTA ACUST UNITED AC 2008; 16:8-18. [PMID: 19089311 DOI: 10.1007/s00534-008-0014-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 04/28/2008] [Indexed: 01/13/2023]
Abstract
BACKGROUND 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. METHODS An extensive review of 160 articles published from 1950 to 2006 concerning 231 cases of CCF was performed. RESULTS 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. CONCLUSION 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.
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Samarkos M, Makrygianni V. Gallstone ileus. CMAJ 2008; 179:203. [PMID: 18625999 DOI: 10.1503/cmaj.080053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michael Samarkos
- 5th Department of Internal Medicine, Evagelismos Hospital, Athens, Greece
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Petrowsky H, Clavien P. Biliary Fistula, Gallstone Ileus, and Mirizzi's Syndrome. DISEASES OF THE GALLBLADDER AND BILE DUCTS 2006:239-251. [DOI: 10.1002/9780470986981.ch14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Lassandro F, Romano S, Ragozzino A, Rossi G, Valente T, Ferrara I, Romano L, Grassi R. Role of helical CT in diagnosis of gallstone ileus and related conditions. AJR Am J Roentgenol 2006; 185:1159-65. [PMID: 16247126 DOI: 10.2214/ajr.04.1371] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Small-bowel obstruction from gallstone impaction is a pathological entity frequently observed in elderly patients with a history of cholelithiasis or cholecystitis. Diagnostic imaging plays a great role in the management of patients with suspected gallstone ileus and overall in the correct predictive diagnosis: in the last years, some experiences in radiologic diagnosis of this entity by sonography, abdominal plain film and CT, and occasionally MRI have been reported. Some questions related to gallstone ileus are to be considered: one of them is the possibility of recurrence, which increases the operatory risk in these patients. Recurrence may be due either to the presence of overlooked stones that were already in the bowel at the time of surgery but not identified and not removed or to the migration of other stones in patients not previously cholcystectomized. In cases of acute abdomen, establishing an effective conservative therapy may be a critical point. The aim of this retrospective study was to evaluate the capabilities of helical single-detector and MDCT scanners to allow a correct diagnosis of this disease. CONCLUSION Helical single-detector and MDCT may improve the diagnosis of gallstone ileus, providing important information regarding the exact number, size, and location of ectopic stones and the site of intestinal obstruction or direct visualization of a biliary-enteric fistula, to help clinicians in the therapeutic management of patients.
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Affiliation(s)
- Francesco Lassandro
- Department of Diagnostic Imaging, A. Cardarelli Hospital, Viale Cardarelli 9, Naples 80131, Italy
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42
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Tseng D, Hunter J. Surgery of the Biliary Tract. ZAKIM AND BOYER'S HEPATOLOGY 2006:1201-1217. [DOI: 10.1016/b978-1-4160-3258-8.50070-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Rodriguez-Sanjuán JC, Casado F, Fernández MJ, Morales DJ, Naranjo A. Cholecystectomy and fistula closure versus
enterolithotomy alone in gallstone ileus. Br J Surg 2005. [DOI: 10.1046/j.1365-2168.1997.02637.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
BACKGROUND Gallstone ileus is a rare disease and accounts for about 1-3% of mechanic ileus of the small bowel, but for 25% of all small bowel obstructions in patients older than 65 years. Concomitant cardiorespiratory diseases or diabetes are frequent in older patients and responsible for the high mortality rate. The aim of the present study was to evaluate and discuss different surgical approaches and to analyze the clinical outcome. METHODS Four patients with a mean age of 72 years were treated for gallstone ileus at our hospital in the last 10 years. Patients history, operative strategy and their outcome is elucidated and a review of the recent literature is given. RESULTS In all patients the operative strategy was a one-stage procedure including enterolithotomy, cholecystectomy and closure of the fistula. The 30-day mortality rate was 25%. CONCLUSION One-stage procedure prevents from cholangitis, cholecystitis and recurrent ileus caused by further gallstones but bears the risk of enteric or biliary leakage after fistula closure. It should therefore be reserved for patients presenting in good general condition with a low degree of cholecystitis.
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Affiliation(s)
- Werner Kirchmayr
- University Hospital Innsbruck, Department of General and Transplant Surgery, Tyrol, Austria.
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Ferraina P, Gancedo MC, Elli F, Nallar M, Ferraro A, Sarotto L, Anzorena FS. Video-assisted laparoscopic enterolithotomy: new technique in the surgical management of gallstone ileus. Surg Laparosc Endosc Percutan Tech 2003; 13:83-7. [PMID: 12709612 DOI: 10.1097/00129689-200304000-00005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Our goal was to analyze the results obtained with the surgical treatment of gallstone ileus using a new video-assisted laparoscopic technique. Six patients with gallstone ileus were admitted to the Hospital de Clínicas José de San Martín of Buenos Aires between March 1996 and April 1998. The patients' charts were retrospectively studied. Five of the six patients were women, with an average age of 71.2 years. Enterolithotomy was performed in four patients, laparoscopic enterolithotomy in one, and diagnostic laparoscopy with no need of further surgical treatment (because the calculus migrated to the colon) in the remaining patient. The postoperative complication rate was 33%. In one patient, acute pulmonary edema and sepsis developed, and death occurred in the immediate postoperative period (mortality rate, 16.6%). The average hospital stay was 6.6 days. The average follow-up was 16 months. No patient required treatment of the enterovesical fistula; all of them remained asymptomatic. One patient died as the result of evolution of vesicular adenocarcinoma. This approach represents a safe and feasible technique that may reduce the morbidity associated with the surgical treatment of gallstone ileus by guiding the surgical incision, preventing unnecessary laparotomies, and improving abdominal exploration.
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Affiliation(s)
- Pedro Ferraina
- Department of Surgery, Division of Gastrointestinal Surgery, Hospital de Clínicas José de San Martin, University of Buenos Aires, Buenos Aires, Argentina
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Shenoy VN, Limbekar S, Long PB, Bashar AA. Relief of small bowel obstruction following colonoscopy in a case of gallstone ileus. J Clin Gastroenterol 2000; 30:326-8. [PMID: 10777200 DOI: 10.1097/00004836-200004000-00027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We describe a patient who presented with mechanical obstruction of the small bowel secondary to impaction of the ileocecal valve from a gallstone. The stone impaction of the ileocecal valve was confirmed by colonoscopy. Although the stone was disimpacted, it could not be trapped and extracted during colonoscopy. Thereafter, the patient's small bowel obstruction was relieved with no further intervention. Even though surgery is the gold standard for the management of gallstone ileus. colonoscopy can be useful in management of patients with gallstone ileus in whom surgery is contraindicated. A review of the literature is also presented.
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Affiliation(s)
- V N Shenoy
- Holzer Clinic/Holzer Medical Centre, Gallipolis, Ohio 45631, USA
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Abstract
Gallstone ileus is a surgical emergency that occurs almost exclusively in the elderly. It is of increasing significance with current demographic changes. Clinical records and diagnostic imaging of 15 consecutive patients treated for gallstone ileus at one hospital over a 6-year period were reviewed. The median patient age was 80 years. Six plain-film diagnoses were made correctly. Contrast studies provided a diagnosis of intestinal obstruction in four patients. Abdominal X-ray findings were assessed incorrectly in two patients, with one false-positive and one false-negative result. The median preoperative hospital stay was 2 days. Three patients had Bouveret's syndrome, two of whom required a gastrostomy and enterolithotomy, and one of whom required a gastroenterostomy. The remaining 12 patients underwent enterolithotomies. Only one patient underwent a cholecystectomy. There was one postoperative death. No patient had biliary symptoms on follow-up. Gallstone ileus is a difficult clinical and radiologic diagnosis. Enterolithotomy alone is adequate treatment in the elderly, and subsequent cholecystectomy is not mandatory.
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Affiliation(s)
- D N Lobo
- Department of Surgery, Nottingham City Hospital, UK.
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48
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Doogue MP, Choong CK, Frizelle FA. Recurrent gallstone ileus: underestimated. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:755-6. [PMID: 9814734 DOI: 10.1111/j.1445-2197.1998.tb04669.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- M P Doogue
- Department of Surgery, Christchurch Hospital and School of Medicine, New Zealand
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Brown DF, Nadel ES. Intermittent abdominal pain in a middle-aged man. J Emerg Med 1997; 15:517-22. [PMID: 9279706 DOI: 10.1016/s0736-4679(97)00102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- D F Brown
- Department of Emergency Medicine, Massachusetts General Hospital, Boston 02114, USA
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50
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Rodriguez-Sanjuán JC, Casado F, Fernández MJ, Morales DJ, Naranjo A. Cholecystectomy and fistula closureversus enterolithotomy alone in gallstone ileus. Br J Surg 1997. [DOI: 10.1002/bjs.1800840514] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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