[Biliary ileus--a missed cause of intestinal obstruction]

Biliary ileus is a rare complication of cholelithiasis, counting for 1-4% of all intestinal obstructions. The aim of the work is to summarize diagnostic and treatment options, assess significance of laparoscopy in this rare form of ileus, based on the authors' own experience and available literature.

The retrospective study analyzed data of patients operated for biliary ileus in the Surgical clinic of the Faculty Hospital in Ostrava during 2002-2006. The following criteria were assessed in the patient group including 9 subjects: gender, age, secondary disorders. ASA (American Society of Anesthesiologists) classification of the subjects, symptomatology, results of preoperative visualization methods examinations and intervals between the disease onset and the procedure. The following peroperative data were collected: duration of the procedure, type of the procedure, complications, obstruction site and concrement size. Duration of postoperative hospitalization and complications arising during this period were recorded.

Concrements were extracted through laparotomy in 5 patients, in 3 subjects the procedure was conducted laparoscopically. In 1 subject, the concrement extraction procedure was conducted together with cholecystectomy and a cholecystoduodenal fistule closure. No complications were recorded peroperatively, in case of the laparoscopic procedure, conversion was not requred. Obstruction site was localized on the jejunum in 3 subjects, on the ileus in 6 subjects. The concrement size ranged from 2x3 cm to 4x6 cm. The mean procedure duration was 61 minutes. The median of postoperative hospitalization was 12 days. During the postoperative period, complications were recorded in 6 subjects, 1 patient exited due to multiorgan failure.

Early timely diagnostics with a significant role of the CT examination is inevitable in patients with rare forms of intestinal obstruction. Adequate surgical management considering the patient's overall condition must be introduced. Taking into consideration the patients age and their polymorbidity, extraction of concrements via enterotomy remains the method of first choice. Duration of postoperative hospitalization depends on frequent complication rates.