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Related Experiment Video

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[Biliary ileus: diagnosis and therapy].

M Roseano1, P Gheller, C Convertino

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Annali Italiani Di Chirurgia
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Gallstone ileus, a bowel obstruction common in the elderly, benefits from one-stage surgical treatment when diagnosed preoperatively. Advanced imaging like CT and MNR improves diagnostic accuracy for this condition.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Radiology

Context:

  • Gallstone ileus accounts for 1-3% of mechanical bowel obstructions.
  • Urgent surgical intervention carries a high mortality rate (10-13%), particularly in elderly patients.
  • Diagnostic and therapeutic challenges in gallstone ileus management are frequently debated.

Purpose:

  • To retrospectively analyze 9 cases of gallstone ileus within a larger cohort of 736 bowel obstructions.
  • To evaluate the accuracy of various diagnostic procedures, including plain abdominal X-ray, ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MNR).
  • To assess surgical outcomes, stratifying patients by the American Society of Anesthesiologists (ASA) physical status classification system and surgical approach.

Summary:

  • Preoperative diagnosis was accurate in 5 out of 9 cases, with non-specific clinical and laboratory findings.
  • Radiological procedure accuracy varied: plain X-ray (1/9), US (4/9), CT (2/3), and MNR (1/1).
  • One-stage treatment (enterolithotomy and fistula repair) was performed in 6 patients, while 3 underwent enterolithotomy alone; no intraoperative mortality occurred, but 4 patients developed wound infections. No recurrences were noted.

Impact:

  • One-stage treatment is supported for correctly diagnosed gallstone ileus, allowing for preoperative optimization in elderly patients.
  • Accurate preoperative diagnosis remains challenging, but CT and MNR demonstrate high sensitivity and specificity.
  • This study highlights the potential to reduce operative risk through timely and accurate diagnosis, favoring a single-stage surgical approach.