Management of gallstone ileus

A recent case of recurrent gallstone ileus prompted a retrospective review of 14 cases of the disease seen at St. Joseph's Hospital, Hamilton, between 1970 and 1986. The condition is uncommon and usually occurs in elderly women who have a history of gallbladder disease and concomitant medical illness. Twelve patients underwent surgery; 1 who had a "one-stage" enterolithotomy, cholecystectomy and repair of fistula died postoperatively. Nine patients who had enterolithotomy alone experienced notable morbidity; they included three who had recurrent biliary tract problems, all of which were managed successfully. The author concludes that enterolithotomy alone should be the standard procedure for gallstone ileus. Cholecystectomy and repair of cholecyst-enteric fistula should be done later only if there are continuing or recurrent symptoms.