[Gallstone disease in the elderly]

The clinical manifestations, management and outcome of gallstone disease in 100 elderly patients are described. A total of 65 patients presented with a complication, acute cholecystitis (43), gallstone pancreatitis (8) and obstructive jaundice (6) being the commonest manifestations. The clinical picture was often misleadingly mild. Associated disease occurred in 70 patients but precluded surgery in only 3. Emergency surgery was indicated in 18 patients. Surgery was performed on 96 patients (cholecystostomy 2, cholecystectomy 94); 35 explorations of the common bile duct were done, with stones present in 33. Four patients died, 1 following an endoscopic retrograde cholangiopancreatography (ERCP) and 3 postoperatively (2 patients with gallstone pancreatitis); no death occurred following an elective operation. Alternative modalities of treatment of gallstone are expected to play a minor role in the management of gallstone disease in the elderly.