Published online May 26, 2020. doi: 10.12998/wjcc.v8.i10.2023
Peer-review started: January 27, 2020
First decision: March 5, 2020
Revised: March 25, 2020
Accepted: April 24, 2020
Article in press: April 24, 2020
Published online: May 26, 2020
The management of recurrent gallstone ileus (GSI) is unsatisfactory, and there is no consensus on how to reduce the incidence of recurrent GSI.
A 79-year-old man presented to the Emergency Department of our hospital complaining of abdominal pain. An abdominal computed tomography (CT) scan revealed cholecystolithiasis, intrahepatic bile duct dilatation, gas accumulation, small intestinal obstruction, and circular high-density shadow in the intestinal cavity. Emergency surgery revealed that the small intestine had extensive adhesions, unclear gallbladder exposure, obvious adhesions, and difficult separation. The obstruction was located 70 cm between the ileum and the ileocecum, which was incarcerated by gallstones, and a simple enterolithotomy was carried out. On the third day after the operation, he had passed gas and defecated and had begun a liquid diet. On the fifth day after the operation, he suddenly experienced abdominal distension and discomfort. Emergency CT examination revealed recurrent GSI, and the diameter of the stone was approximately 2.0 cm (consistent with the shape of cholecystolithiasis on the abdominal CT scan before the first operation). The patient’s symptoms were not significantly relieved after conservative treatment. On the ninth day after the operation, emergency enterolithotomy was performed again along the original surgical incision. On the twentieth day after the second operation, the patient fully recovered and was discharged from the hospital.
We believe that a thorough examination of the bowel and gallbladder for gallstones based on preoperative imaging during surgery and removal of them as far as possible on the premise of ensuring the safety of patients are an effective strategy to reduce the recurrence of GSI.
Core tip: There is no consensus on how to effectively reduce the recurrence rate of recurrent gallstone ileus (GSI). Herein, we present a rare case of recurrent GSI, in order to elucidate and review the pathogenesis, presentation, diagnosis, and consensus recommendations regarding the management of recurrent GSI. This case highlights the importance of a detailed abdominal physical examination and imaging data interpretation before the operation, as well as a systematic and careful search for the existence of other residual stones during the operation on the premise of ensuring safety. Enterolithotomy combined with cholecystectomy or gallbladder lithotomy is an effective strategy for reducing the recurrence of GSI.