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Gallstone ileus.

P A Clavien1, J Richon, S Burgan

  • 1Department of Surgery, University Hospital, Geneva, Switzerland.

The British Journal of Surgery
|July 1, 1990
PubMed
Summary
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Gallstone ileus diagnosis is often delayed, requiring advanced imaging. A one-stage surgical procedure for gallstone ileus is a viable option, especially when feasible, to reduce complications.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Abdominal Surgery

Background:

  • Gallstone ileus is a rare complication of gallstones, often affecting elderly patients with comorbidities.
  • Diagnosis can be challenging, with plain radiographs having limited sensitivity.

Purpose of the Study:

  • To evaluate the diagnostic methods, surgical approaches, and outcomes for patients with gallstone ileus.
  • To compare the efficacy and safety of different surgical strategies.

Main Methods:

  • Retrospective analysis of 37 patients operated on for gallstone ileus over 12 years.
  • Review of diagnostic imaging (radiographs, ultrasonography, CT scans) and surgical interventions (one-stage, two-stage, enterolithotomy alone).

Main Results:

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  • Diagnosis was made preoperatively in 73% of cases, but only 46% at admission.
  • Terminal ileum was the most common obstruction site (73%).
  • One-stage procedures had a higher mortality (2/8) compared to two-stage (0/6), but enterolithotomy alone had significant later biliary complications (5 deaths).

Conclusions:

  • A one-stage procedure for gallstone ileus is a valid and potentially preferred option when feasible.
  • Two-stage procedures are recommended if local conditions preclude a one-stage approach and residual stones exist.
  • Non-operative methods may be considered for high-risk patients.