Gallstone ileus as an unexpected complication of cholelithiasis: diagnostic difficulties and treatment (original) (raw)
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Gallstone ileus managed with enterolithotomy
BMJ Case Reports, 2019
Although gallstone disease is classically associated with the inflammatory sequela of cholecystitis, other presentations include gallstone ileus, Mirizzi syndrome, Bouveret syndrome and gallstone ileus. Gallstone ileus occurs when a gallstone passes from a cholecystoduodenal fistula into the gastrointestinal tract and causes obstruction, usually at the ileocaecal valve. It represents an uncommon complication of cholelithiasis, accounting for 1%–4% of all cases of mechanical bowel obstruction and 25% of all cases in individuals aged >65 years. It has a female predilection. Clinical presentation depends on the site of the obstruction. Diagnosis can prove challenging with the diagnosis rendered in 50% of cases intraoperatively. The authors present the case of a 79-year-old woman with a 10-day history of abdominal pain, nausea, vomiting and episodes of loose stools. An abdominal radiograph showed mildly distended right small bowel loops. Further investigation with a CT of the abdomen...
Cirugia y cirujanos, 2015
Recurrent gallstone ileus, an uncommon mechanical intestinal obstruction secondary to occlusion of the intestine by an intraluminal biliary calculus. Female, 75years old, ischemic heart disease (stent), came to our department complaining of abdominal pain and vomiting. Computed tomography (CT) showed gallstone ileus. The patient suffered an enterotomy with gallstone removal. Three months later, the patient came back with the same clinical symptoms and signs. A new CT highlighted a gallstone ileus again. We proceed with enterolithotomy and gallstone removal, cholecystectomy and closure of cholecystoduodenal fistula. The patient had a prolonged hospital stay due to the development of congestive heart failure. Case 2. Male, 71years old, ischemic heart disease and aortocoronary bypass, came to our department complaining of vomiting. CT showed aerobilia and gallstone ileus. The patient suffered an urgent enterolithotomy. Seven months later, the patient came back with the same clinical sy...
Gallstone Ileus: Diagnostic and Surgical Dilemma
Journal Current Surgery, 2012
Background: The typical patient with Gallstone ileus is female, elderly, with concomitant medical diseases and high operative risk. This disease is becoming more common as a result of increase the aging population. Its diagnosis is difficult and early diagnosis could reduce the mortality. Nowadays the use of new imaging techniques can expedite the correct diagnosis, decreasing preoperative delay. However, controversy persists primarily in relation to surgical strat-egy. Methods: We retrospectively reviewed the medical records of all patients with the diagnosis of intestinal obstruction between 1998 and 2011. We took into consideration concomitant medical conditions, previous history of cholelithiasis, operative risk (ASA score), preoperative findings, duration and type of surgery, post-operative outcome, 30-day mortality. Results: The incidence was 0.66% (4 out of 601 cases of intestinal obstruction), 1% if we consider small bowel obstruction only (399 cases), 2.01% in patients over the age of 65 (199 out of 601) and 3.73 % in patients over the age of 80 (107 out of 601). In cases of small bowel obstruction resulting in impacted foreign body the incidence was 36.36 %. All patients were female with a mean age of 81.7 (range 75 - 86). The proper diagnosis prior to surgery was assessed in 2 out of 4 cases. In one case enterolithotomy was completed in one stage with cholecystectomy and closure of the fistula during acute surgery, while in 3 cases enterolithotomy alone was performed, 1 patient operated enterolithotomy alone died on the 14th postoperative. Conclusions: The history, clinical, and radiologic findings are often nonspecific suggesting only a small bowel obstruction. Nowadays the use of new imaging techniques, in combination with plain abdominal radiographs, can expedite the correct diagnosis in over 50% of cases decreasing preoperative delay. The type of intervention does not significantly influence post-operative morbidity and mortality rates. We believe to perform simple enterolithotomy as procedure of choice, while the one-stage procedure should be performed in patients with greater life expectancy, less operative risk and comorbidity.
Journal of Medical Science And clinical Research, 2016
A 88yr old female known case of diabetes, hypertension and CKD presented with fever and Chills for 15 days with yellowish discolouration of sclera and urine for 5 days. On evaluation she was found to have evidence of Calculus Cholecystitis, Choledocholithiasis and Cholangitis. Patient was managed with IV fluid, IV antibiotics and other supportive treatment. ERCP was planned. After CBD Cannulation with Sphincterotomy and ballon sweeping, Pus, fragmented stones and black bile came out. After multiple ballon sweeping and clearing CBD plastic stent was placed.Patient was discharged as she was asymptomatic after 7 days. Removal of GB was deferred as patient's family denied the same. However after 15days she presented with recurrent vomiting and abdominal distension. CT abdomen revealed large Cholecysto-enteric fistula and Calculus within mid small bowel suggestive of gall stone ileus. Exploratory laparotomy with enterostomy was done.
Cholecystostomy does not prevent gallstone ileus: a case report
Cases Journal, 2009
Introduction: Gallstone ileus following cholecystostomy has been reported once, in a patient with acute cholecystitis, where symptoms of small intestinal obstruction had developed one day after surgery. We report a case of gallstone ileus eight months following a cholecystostomy, which might deter the diagnosis. This is the only such reported case in medical literature according to our knowledge. Case presentation: A 54-year-old Sri Lankan female with a past history of a cholecystostomy presented with symptoms suggestive of small intestinal obstruction. Evidence of ileal obstruction with pneumobilia in the supine radiograph of the abdomen and cholecyto-duodenal fistula in the water soluble contrast study was suggestive of the diagnosis of gallstone ileus. An enterolithotomy was performed with no attempt of closure of the cholecysto-duodenal fistula. Conclusion: This case demonstrates the value of the supine radiograph of the abdomen and the barium follow-through in diagnosis. A cholecystogram, preferably preoperative, is the mainstay of prevention and identification of this clinical scenario.
GALLSTONE ILEUS; REVIEW OF THE LITERATURE WITH 3 CASES Safrataşı ileusu; 3 olgu ve literatür sunumu
Cer San D (J Surg Arts), 2014;7(2):99-102. http://dx.doi.org/10.14717/jsurgarts.2014.140 ABSTRACT Gallstone ileus, an unusual complication of cholelithiasis that commonly found in elderly patients. A biliary-enteric fistula allows the passage of one or more large gallstones and causes mechanical intestinal obstruc-tion due to impaction of gallstones within the gastrointestinal tract. In this paper, we report our three cases who were treated without fistula repair. All three patients had significant risk factors with advanced ages. We performed enterolithotomy for intestinal obstruction in two cases. After a 12 months follow-up, they remain in good health. In the third patient we performed a tranvers colotomy and removed the impacted stone. But 5 days after the surgery, the patient died due to respiratory failure. There is no uniform surgical procedure for gallstone ileus. Enterolithot-omy remains the most reported procedure in the literature. In high risk patients and if biliary sur...