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Abuzaina K, Fakhouri S, Makhamre ZIH, Alzatari WKA, Hazaza MAB, Jawabreh LNY. Gallstone ileus: An unusual complication of cholelithiasis in a 42-year-old female with no comorbidities. Int J Surg Case Rep 2024; 117:109533. [PMID: 38518460 PMCID: PMC10973716 DOI: 10.1016/j.ijscr.2024.109533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Gallstone ileus is a rare condition, accounting for 0.5 % of mechanical small bowel obstructions. It is a misnomer for mechanical intestinal obstruction caused by one or more gallstones impacted within the gastrointestinal tract lumen, which occurs mostly in the elderly and female population. Treated usually by operative enterolithotomy. Preoperative diagnosis is challenging, but CT, which is investigation of choice, and magnetic resonance imaging (MRI) have made it easier to diagnose. CASE PRESENTATION A 42-year-old female presented to the emergency department with epigastric abdominal pain for 1 week, preceded by 2 months of RUQ pain. CT scan with contrast showed a classical finding of small bowel obstruction and ectopic gallstone. An emergency exploratory laparotomy, enterolithotomy, and cholecystectomy with fistula repair were performed in one surgical stage. CLINICAL DISCUSSION Laparoscopic enterolithotomy alone is the most preferred method due to its low incidence of complications but one-stage or two-stage surgeries are also options, but the choice between surgical modalities depends on the patient's status. CONCLUSION Gallstone ileus mostly affects older female patients who have a history of gallbladder disease and often have a poor prognosis that becomes worse with age and comorbidities. However, this was a young female patient with no comorbidities, which may affect the prognosis compared to those who are at risk for gallstone ileus.
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Affiliation(s)
- Khalil Abuzaina
- Assisted professor of General Surgery, at Hebron University, State of Palestine.
| | - Sulaiman Fakhouri
- Assisted professor of General Surgery, at Palestine Polytechnique University, State of Palestine
| | - Zahra I H Makhamre
- Medical student at Palestine Polytechnique University, State of Palestine
| | - Wala' K A Alzatari
- Medical student at Palestine Polytechnique University, State of Palestine
| | - Merna A B Hazaza
- Medical student at Palestine Polytechnique University, State of Palestine
| | - Leen N Y Jawabreh
- Medical student at Palestine Polytechnique University, State of Palestine
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Matli VVK, Marler KC, Morgan A, Pujala V, Pandit S, Morris J. Gallstone Enteropathy: An Unusual Cause of Bowel Obstruction. Cureus 2023; 15:e44707. [PMID: 37809230 PMCID: PMC10552588 DOI: 10.7759/cureus.44707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Gallstones causing bowel obstruction, known as gallstone ileus, are rare and account for less than 0.5% of small bowel obstruction cases. Additionally, it is a rare complication affecting only 0.3% of patients who have gallstones. Fistula formation between the biliary system, most commonly between the gallbladder and duodenum because of their proximity, facilitates the migration of gallstones into the enteric system with subsequent impaction in the small intestine, usually in the distal ileum close to the ileocecal valve, promoting the development of mechanical small bowel obstruction. Computerized tomography of the abdomen and pelvis is a confirmatory and widely used imaging study when there are two signs of Rigler's triad, which includes pneumobilia, evidence of small bowel obstruction and the presence of radiopaque stones. We report a case of a 75-year-old Caucasian man who presented with abdominal distention with signs of severe dehydration secondary to intractable nausea and vomiting complicated with severe acute kidney injury and was found to have a 4.7-centimeter gallstone-induced small intestinal obstruction.
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Affiliation(s)
| | - Kevin C Marler
- General Surgery, Christus Highland Medical Center, Shreveport, USA
| | - Andre Morgan
- Internal Medicine, Christus Highland Medical Center, Shreveport, USA
| | - Varsha Pujala
- Internal Medicine, Christus Highland Medical Center, Shreveport, USA
| | - Sudha Pandit
- Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - James Morris
- Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Shreveport, USA
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Rey Chaves CE, Villamil CJ, Ruiz S, Galvis V, Conde D, Sabogal Olarte JC. Cholecystogastric fistula in Bouveret syndrome: Case report and literature review. Int J Surg Case Rep 2022; 93:106918. [PMID: 35339038 PMCID: PMC8957017 DOI: 10.1016/j.ijscr.2022.106918] [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: 01/24/2022] [Revised: 02/15/2022] [Accepted: 03/05/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Cholelithiasis is the benign bile pathology with major prevalence. A rare condition has been described, when a stone migrates through the duodenum causing small bowel obstruction (SBO), it's known as Bouveret syndrome, and it's attributed to almost 5% of SBO. Just 2% of the cases present with the migration of the stone through a fistula between gastric chamber and gallbladder, with limited reports in the literature. CLINICAL FINDINGS We present a case of an 87-year-old male with Bouveret syndrome and a cholecystogastric fistula with a stone in the gastric chamber who underwent laparoscopic gastrotomy to resolve the clinical case. CONCLUSION Bouveret syndrome remains to be a rare condition in benign bile pathology. Individualized treatment should be performed and multidisciplinary approach leads to improved outcomes for the patient.
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Affiliation(s)
- Carlos Eduardo Rey Chaves
- Faculty of Medicine, Universidad del Rosario, Colombia; Hospital Universitario Mayor Méderi, Colombia.
| | | | - Saralia Ruiz
- Faculty of Medicine, Universidad del Rosario, Colombia
| | | | - Danny Conde
- Faculty of Medicine, Universidad del Rosario, Colombia; Hospital Universitario Mayor Méderi, Colombia
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Vera-Mansilla C, Sanchez-Gollarte A, Matias B, Mendoza-Moreno F, Díez-Alonso M, Garcia-Moreno Nisa F. Surgical Treatment of Gallstone Ileus: Less Is More. Visc Med 2022; 38:72-77. [PMID: 35291697 PMCID: PMC8874244 DOI: 10.1159/000518451] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2025] Open
Abstract
INTRODUCTION The objective of this study was to evaluate the need for cholecystectomy in patients who underwent surgery for gallstone ileus. METHODS This was a retrospective review of the clinical history of patients who underwent surgery for gallstone ileus between December 1992 and December 2018 and follow-up until October 2020. Data regarding the surgical intervention, location of the obstruction, and surgical procedure performed were collected, as well as complications in relation to biliary pathology in the postoperative period. RESULTS Twenty-five patients underwent surgery for gallstone ileus. In all patients, except one, the site of the obstruction was identified. The mean age of the patients was 72 (standard deviation [SD] 13.3) years, with a female predominance (18: 7). The patients presented symptoms, on average, 2.9 (1-7) days before going to the emergency room; the primary symptoms were vomiting associated with abdominal pain and constipation (56%). Fifty-six percent of patients were diagnosed preoperatively by imaging tests. In 72% of patients, an enterolithotomy was performed alone without any other intervention on the gallbladder or bile duct. Eighty-three percent of the patients did not present any cholecystobiliary complications during the entire follow-up period, and urgent or delayed cholecystectomy was not performed after the acute episode. CONCLUSIONS Gallstone ileus is a rare entity, and there are no randomized studies that support a preferred treatment. If surgical intervention is required, enterotomy for stone extraction is a safe and effective technique, and in our experience, urgent or delayed cholecystectomy is not necessary.
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Affiliation(s)
- Cristina Vera-Mansilla
- General Surgery Department, Hospital Universitario Príncipe de Asturias, Alcala de Henares, Spain
| | - Ana Sanchez-Gollarte
- General Surgery Department, Hospital Universitario Príncipe de Asturias, Alcala de Henares, Spain
| | - Belen Matias
- General Surgery Department, Hospital Universitario Príncipe de Asturias, Alcala de Henares, Spain
| | - Fernando Mendoza-Moreno
- General Surgery Department, Hospital Universitario Príncipe de Asturias, Alcala de Henares, Spain
| | - Manuel Díez-Alonso
- General Surgery Department, Hospital Universitario Príncipe de Asturias, Alcala de Henares, Spain
| | - Francisca Garcia-Moreno Nisa
- General Surgery Department, Hospital Universitario Príncipe de Asturias, Alcala de Henares, Spain
- Department of Surgery and Medical and Social Sciences, GIBBYC-UAH CIBER-BBN IRYCIS, Universidad de Alcalá, Alcala de Henares, Spain
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Abstract
Small bowel obstruction (SBO) remains a common problem for surgeons and nonsurgeons alike. Management of SBO has shifted from primarily being surgical to a nonoperative approach, which can be attributed to a multitude of reasons, including better understanding of the pathophysiology of SBO, the advent of laparoscopy, and improvement in diagnostic imaging. But given the nature of SBO, the need for surgical consultation continues to remain a necessity. This article will review the etiology, diagnosis, and management of SBO.
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Affiliation(s)
- Allison A Aka
- Department of Colon and Rectal Surgery, AdventHealth Orlando, Orlando, Florida
| | - Jesse P Wright
- Department of Colon and Rectal Surgery, AdventHealth Orlando, Orlando, Florida
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Cholecystoduodenal fistula, an infrequent complication of cholelithiasis: Our experience in its surgical management. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2017.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Ploneda-Valencia C, Gallo-Morales M, Rinchon C, Navarro-Muñiz E, Bautista-López C, de la Cerda-Trujillo L, Rea-Azpeitia L, López-Lizarraga C. Gallstone ileus: An overview of the literature. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017. [DOI: 10.1016/j.rgmxen.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ploneda-Valencia CF, Gallo-Morales M, Rinchon C, Navarro-Muñiz E, Bautista-López CA, de la Cerda-Trujillo LF, Rea-Azpeitia LA, López-Lizarraga CR. Gallstone ileus: An overview of the literature. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:248-254. [PMID: 28433486 DOI: 10.1016/j.rgmx.2016.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/07/2016] [Accepted: 07/28/2016] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Gallstone ileus represents 4% of the causes of bowel obstruction in the general population, but increases to 25% in patients above the age of 65 years. Gallstone ileus does not present with unique symptoms, making diagnosis difficult. Its management is surgical, but there is no consensus as to which of the different surgical techniques is the procedure of choice. At present, there is no recent review of this pathology. AIM To conduct an up-to-date review of this disease. MATERIALS AND METHODS Articles published within the time frame of 2000 to 2014 were found utilizing the PUBMED, EMBASE, and Cochrane Library search engines with the terms "gallstone ileus" plus "review" and the following filters: "review", "full text", and "humans". RESULTS The results of this review showed that gallstone ileus etiology was due to intestinal obstruction from a gallstone that migrated into the intestinal lumen through a bilioenteric fistula. The presence of 2 of the 3 Rigler's triad signs was considered diagnostic. Abdominal tomography was the imaging study of choice for gallstone ileus diagnosis and the surgical procedures for management were enterolithotomy, one-stage surgery, and two-stage surgery. Enterolithotomy had lower morbidity and mortality than the other 2 procedures. CONCLUSIONS The aim of gallstone ileus treatment is to release the obstruction, which is done through enterolithotomy. It is the recommended technique for gallstone ileus management because of its lower morbidity and mortality, compared with the other techniques.
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Affiliation(s)
- C F Ploneda-Valencia
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México.
| | - M Gallo-Morales
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
| | - C Rinchon
- Escuela de Medicina y Odontología Schulich, Universidad de Western Ontario, London, Ontario, Canadá
| | - E Navarro-Muñiz
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
| | - C A Bautista-López
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
| | - L F de la Cerda-Trujillo
- Servicio de Investigación Clínica, Departamento de Cirugía, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
| | - L A Rea-Azpeitia
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
| | - C R López-Lizarraga
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
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Aguilar-Espinosa F, Maza-Sánchez R, Vargas-Solís F, Guerrero-Martínez GA, Medina-Reyes JL, Flores-Quiroz PI. Cholecystoduodenal fistula, an infrequent complication of cholelithiasis: Our experience in its surgical management. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:287-295. [PMID: 28389051 DOI: 10.1016/j.rgmx.2016.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/02/2016] [Accepted: 10/27/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Bilioenteric fistulas are the abnormal communication between the bile duct system and the gastrointestinal tract that occurs spontaneously and is a rare complication of an untreated gallstone in the majority of cases. These fistulas can cause diverse clinical consequences and in some cases be life-threatening to the patient. AIM To identify the incidence of bilioenteric fistula in patients with gallstones, its clinical presentation, diagnosis through imaging study, surgical management, postoperative complications, and follow-up. MATERIALS AND METHODS A retrospective study was conducted to search for bilioenteric fistula in patients that underwent cholecystectomy at our hospital center due to cholelithiasis, cholecystitis, or cholangitis, within a 3-year time frame. RESULTS Four patients, 2 men and 2 women, were identified with cholecystoduodenal fistula. Their mean age was 81.5 years. Two of the patients presented with acute cholangitis and 2 presented with bowel obstruction due to gallstone ileus. All the patients underwent surgical treatment and the diagnostic and therapeutic management of each of them was analyzed. CONCLUSIONS The incidence of cholecystoduodenal fistula was similar to that reported in the medical literature. It is a rare complication of gallstones and its diagnosis is difficult due to its nonspecific symptomatology. It should be contemplated in elderly patients that have a contracted gallbladder with numerous adhesions.
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Affiliation(s)
- F Aguilar-Espinosa
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México.
| | - R Maza-Sánchez
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - F Vargas-Solís
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - G A Guerrero-Martínez
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - J L Medina-Reyes
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - P I Flores-Quiroz
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
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Aguilar-Espinosa F, Gálvez-Romero JL, Falfán-Moreno J, Guerrero-Martínez GA, Vargas-Solís F. [Gastrointestinal bleeding and delirium, challenges in the diagnosis of gallstone ileus: A case report and review of literature]. CIR CIR 2017; 85 Suppl 1:53-57. [PMID: 28110901 DOI: 10.1016/j.circir.2016.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 10/24/2016] [Accepted: 11/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gallstone ileus is a non-strangulated mechanical obstruction of the small bowel or colon as a result of the passage of gallstones through a biliary enteric fistula. It is a rare complication of cholelithiasis, affects patients over 65 years, and the disease occurs predominantly in females. Preoperative diagnosis is difficult due to the lack of specific signs and symptoms in elderly patients with multiple comorbidities. CLINICAL CASE A 93-year-old female presenting with a one-week history of upper gastrointestinal bleeding, electrolyte imbalance and community- acquired pneumonia pneumonia. During her prolonged hospital stay she presented an intestinal obstruction. The diagnosis of gallstone ileus was made by CT scan. Despite surgical treatment, she died due to late diagnosis. CONCLUSIONS Gallstone ileus is a rare pathology, difficulty in diagnosis prolongs hospital stay, which directly influences mortality.
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Affiliation(s)
- Francisco Aguilar-Espinosa
- Servicio de Cirugía General, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México.
| | - José Luis Gálvez-Romero
- Servicio de Inmunoalergología, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México
| | - Jesús Falfán-Moreno
- Servicio de Cirugía General, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México
| | - Gustavo Adolfo Guerrero-Martínez
- Servicio de Cirugía General, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México
| | - Facundo Vargas-Solís
- Servicio de Cirugía General, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México
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[Gallstone ileus, experience in the Dr. Eduardo Liceaga General Hospital of Mexico]. CIR CIR 2016; 85:114-120. [PMID: 27567045 DOI: 10.1016/j.circir.2016.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/03/2015] [Accepted: 05/31/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Gallstone ileus is a rare cause of intestinal obstruction (1-4%). It results from the migration of a gallstone through a bilio-enteric fistula. Treatment begins with fluid therapy, followed by enterolithotomy, fistula closure, and cholecystectomy. OBJECTIVES To determine the clinical presentation in patients with gallstone ileus and subsequent medical -surgical management outcomes. MATERIAL AND METHODS A retrospective, observational, descriptive and transversal study was conducted on patients diagnosed with intestinal obstruction secondary to a gallstone ileus from May 2013 to October 2014. The following variables were recorded: age, sex, comorbidities, mean time of onset of symptoms, length of preoperative and postoperative stay, imaging studies, biochemical tests, type of surgical management, stone location and size, complications, mortality, and postoperative follow-up. RESULTS The study included 10 patients (male: female ratio 1:4), with a mean age of 61.9 years. The mean time of onset symptoms 15.4 days, and preoperative stay was 2days. On admission, 80% of patients had leukocytosis and neutrophilia, and 70% with renal failure. The most common surgical management was enterolithotomy with primary closure (50%), finding 80% of the stones in the terminal ileum. Recurrence was found in 2 cases. Mean postoperative hospital stay was 6.3 days. Mortality was 20%. CONCLUSIONS Gallstone ileus most commonly presented in women in the seventh decade of life, with intermittent bowel obstruction. On hospital admission, they presented with systemic inflammatory response, electrolyte imbalance and abnormal liver function tests. Initial treatment must include fluid-electrolyte replacement, and tomography scans must be made in all cases. In our experience, the best procedure is enterolithotomy and primary closure, which presented lower morbidity and mortality.
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Abstract
Bouveret's syndrome is a rare cause of gastric outlet obstruction. Its diagnosis is often delayed or overlooked. It is characterized by the passage of a large gall bladder stone through a bilio-duodenal fistula, which becomes lodged in the duodenum causing duodenal obstruction. We report the case of a 70-year-old male with a history suggestive of gall bladder disease over a 1-year period. The diagnosis was confirmed by ultrasound, which showed a single large gall bladder stone and the patient was planned for elective laparoscopic cholecystectomy. One week prior to the elective surgery he presented with upper gastrointestinal bleeding for which he was admitted, diagnosed by a gastroenterologist as bleeding duodenal ulcer and treated by local epinephrine injection and blood transfusion. One week later he presented with a picture of acute gastric outlet obstruction, which proved by endoscopy to be due to a large stone impacted in the duodenum. Endoscopic management failed and the stone was managed by open surgery. The patient made a good postoperative recovery and for the last year he has remained free of symptoms.
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Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL. Gallstone ileus, clinical presentation, diagnostic and treatment approach. World J Gastrointest Surg 2016; 8:65-76. [PMID: 26843914 PMCID: PMC4724589 DOI: 10.4240/wjgs.v8.i1.65] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/28/2015] [Accepted: 12/08/2015] [Indexed: 02/07/2023] Open
Abstract
Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract. Less than 1% of cases of intestinal obstruction are derived from this etiology. The symptoms and signs of gallstone ileus are mostly nonspecific. This entity has been observed with a higher frequency among the elderly, the majority of which have concomitant medical illness. Cardiovascular, pulmonary, and metabolic diseases should be considered as they may affect the prognosis. Surgical relief of gastrointestinal obstruction remains the mainstay of operative treatment. The current surgical procedures are: (1) simple enterolithotomy; (2) enterolithotomy, cholecystectomy and fistula closure (one-stage procedure); and (3) enterolithotomy with cholecystectomy performed later (two-stage procedure). Bowel resection is necessary in certain cases after enterolithotomy is performed. Large prospective laparoscopic and endoscopic trials are expected.
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Ploneda-Valencia CF, Sainz-Escárrega VH, Gallo-Morales M, Navarro-Muñiz E, Bautista-López CA, Valenzuela-Pérez JA, López-Lizárraga CR. Karewsky syndrome: A case report and review of the literature. Int J Surg Case Rep 2015; 12:143-5. [PMID: 26073917 PMCID: PMC4486403 DOI: 10.1016/j.ijscr.2015.05.034] [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: 02/03/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Gallstone ileus can be a lethal disease, rarely suspected in the clinical scenario. It represents about 25% of all bowel obstruction cases in patients older than 65. There is a classification of gallstone ileus based on the onset time: acute, subacute and chronic (Karewsky syndrome). We describe the first reported case of chronic gallstone ileus. CASE PRESENTATION A 78-year-old female was admitted to the ER with a 15-day case of consistent bowel obstruction. The subject reported a five-year history of recurrent hospital admissions that resolved spontaneously after non-surgical management. Karewsky syndrome was diagnosed and managed with enterolithotomy. After five days of postoperative evolution the patient was discharged, and at six months follow up, no other hospital admission or relapse has been registered. DISCUSSION The gallstone ileus diagnosis demands a higher clinical suspicion, there is no biochemical marker, and an abdominal CT is ideal for imaging-based diagnosis. There is no consensus on the optimal surgical approach. CONCLUSION We describe the first case of Karewsky syndrome and a gastro-jejune and gastric-choledochus double fistula. We emphasize the importance of higher clinical suspicion for patients with bowel obstruction older than 65 years old and make evident that although there are not evidence-based guidelines for this treatment, enterolithotomy is a recommended approach.
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Affiliation(s)
| | | | | | - Eliseo Navarro-Muñiz
- ME en cirugía general jefe del Servicio de Cirugía General del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | - Carlos Alfredo Bautista-López
- ME en cirugía general adscrito al Servicio de Cirugía General del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | - Jesús Alonso Valenzuela-Pérez
- ME en cirugía general adscrito al Servicio de Cirugía General del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | - Carlos René López-Lizárraga
- ME en cirugía general jefe de la División de Cirugía del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico.
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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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Bircan HY, Koc B, Ozcelik U, Kemik O, Demirag A. Laparoscopic treatment of gallstone ileus. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:75-7. [PMID: 25187746 PMCID: PMC4133753 DOI: 10.4137/ccrep.s16512] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/08/2014] [Accepted: 06/12/2014] [Indexed: 12/11/2022]
Abstract
Gallstone ileus is a rare complication of cholelithiasis that has high morbidity and mortality. An intestinal obstruction can be caused by migration of a large gallstone through a biliary enteric fistula or by impaction within the intestinal tract. In this study, we present the case of an 81-year-old woman with a mechanical bowel obstruction by a gallstone that was treated by laparoscopy.
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Affiliation(s)
- Huseyin Y Bircan
- Department of Surgery, Baskent University, Faculty of Medicine, Istanbul Research Hospital, Istanbul, Turkey
| | - Bora Koc
- Department of Surgery, Baskent University, Faculty of Medicine, Istanbul Research Hospital, Istanbul, Turkey
| | - Umit Ozcelik
- Department of Surgery, Baskent University, Faculty of Medicine, Istanbul Research Hospital, Istanbul, Turkey
| | - Ozgur Kemik
- Department of Surgery, Yuzuncu Yil University, Medical Faculty, Van, Turkey
| | - Alp Demirag
- Department of Surgery, Baskent University, Faculty of Medicine, Istanbul Research Hospital, Istanbul, Turkey
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