[Intestinal obstruction by biliary ileus; clinical experience and literature review]

Gallstone ileus is an unusual and peculiar complication of biliary lithiasis. Less than 1% of gallstones migrate into the gut, causing 25% of non-strangulated small bowell obstructions in elderly population. Diagnosis is difficult, leading to late operation. Considering the median age of the patients and the fact that in most cases surgery is delayed, there is a lot of dispute regarding the best approach. Recent technical facilities in diagnostic and surgical practice seem to be irrelevant for the general outcome.

All 6 patients operated since 1981 (median age 67 years, 5 female) were retrospectively analyzed, to determine the most valid option. Biliary ileus was recorded in 0.16% of all operations for billiard lithiasis and 1.52% of all enteric occlusions. There was a mean delay of 4.2 days for onset of symptoms to admission and further 5 days to surgery. Particular elements suggesting the ethiology were absent in most cases. In all cases the gallstone migrated in the duodenum. The obstruction was jejunal (3 patients), proximal ileal (2 patients) and distal ileal (1 patient). Enterolithotomy was practiced in 3 cases, with subsequent cholecystectomy and fistula closure in 1 case; one-stage repair in 2 cases and enterolithotomy with temporary external drainage of the fistula (cholecystostomy) in 1 patient.

There were no specific (fistular) complications; 1 aged patient with distal occlusion died because of severe metabolic disorders. The most "favourable" cases were those with very large gallstones occluding the jejunum. Smaller stones were less symptomatic, resulting in delayed diagnosis and surgery; the more aboral the occlusion, more indication for abstention regarding primary repair of the fistula.