Gallstone ileus: diagnosis and management.

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Abdominal Surgery

Background:

• Gallstone ileus is a rare but serious complication of cholelithiasis, primarily affecting the elderly.
• It represents 1%-4% of mechanical bowel obstructions, carrying significant morbidity and mortality risks.

Purpose of the Study:

• To present institutional experience with gallstone ileus.
• To discuss current literature and management strategies for this condition.

Main Methods:

• Retrospective review of medical records (January 1998 - December 2005).
• Patients coded for gallstone ileus (ICD K-563).
• Analysis of diagnostic methods, surgical procedures, and outcomes.

Main Results:

• 22 elderly patients (mean age 77) with a 4.5:1 female to male ratio.
• Abdominal pain and vomiting were common presenting symptoms.
• Preoperative diagnosis achieved in 77% using imaging (X-ray, ultrasound, CT); 86.4% were ASA class 3 or 4.
• Enterolithotomy alone was performed in 20 patients; two had a one-stage procedure.
• Mean impacted stone size was 3.6 cm, typically in the ileum (17 patients) or jejunum (5 patients).
• Five perioperative deaths occurred; one patient developed cholangitis 18 months post-enterolithotomy.

Conclusions:

• Gallstone ileus is diagnostically challenging.
• Advanced imaging techniques enhance diagnostic accuracy and expedite treatment decisions.
• Individualized management is crucial; one-stage procedures are reserved for select patients with good cardiorespiratory reserve and clear biliary indications.