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Disease spectrum and use of cholecystolithotomy in gallstone ileus transection
Nicholas E Williams1, Justin S Gundara, Sophia Roser
1Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, University of Sydney, St. Leonards, Sydney, NSW 2065, Australia.
Insights
Gallstone ileus management varies. Cholecystolithotomy can effectively treat recurrent gallstone ileus (Bouveret's syndrome) in elderly patients unsuitable for definitive surgery, balancing risks and recurrence.
Area of Science:
- Gastroenterology
- Abdominal Surgery
Background:
- Gallstone ileus presents diagnostic and management challenges due to its heterogeneity and high morbidity.
- Lack of consensus exists regarding optimal timing and approach for managing the biliary tree and associated fistulas in gallstone ileus.
Observation:
- This study presents three cases illustrating the spectrum of gallstone ileus, including Barnard's and Bouveret's syndromes.
- Case details cover clinical presentation, diagnostic imaging, surgical techniques, and patient outcomes.
Findings:
- One patient with recurrent gallstone ileus (Barnard's syndrome) underwent successful cholecystolithotomy, minimizing risks of complex biliary surgery.
- Two cases of Bouveret's syndrome were managed via enterolithotomy/cholecystectomy and multivisceral resection, demonstrating diverse treatment strategies.
Implications:
- For elderly, compromised patients, cholecystolithotomy offers an alternative to high-risk, one-stage definitive surgery, mitigating recurrence risk.
- Open cholecystolithotomy is suggested for residual gallstone removal in patients not candidates for definitive biliary surgery.
Background:
Gallstone ileus is a heterogeneous and highly morbid condition that suffers from a lack of consensus regarding the timing and approach to management of the biliary tree and associated fistula.
Methods:
We report three cases that demonstrate the spectrum of gallstone ileus with classical examples of both Barnard's and Bouveret's syndromes. Clinical presentation, diagnostic imaging, surgical technique and outcome are discussed.
Results:
One patient with Barnard's syndrome presented with recurrent gallstone ileus. To minimize the risks of complex, definitive biliary surgery and avoid further recurrent episodes, a cholecystolithotomy was performed with effect. Two cases of Bouveret's syndrome were successfully managed with enterolithotomy/cholecystectomy and multivisceral resection respectively, thus highlighting the diverse nature of this disease and management options.
Conclusions:
Following enterolithotomy, potentially morbid, definitive one-stage surgery in typically compromised, elderly patients needs to be weighed against the risk of recurrence and ongoing biliary pathology. We suggest the use of open cholecystolithotomy for the removal of residual gallstones when the patient is not suitable for definitive biliary surgery.
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