Gallstone ileus: monocentric experience looking for the adequate approach

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Abdominal Surgery

Background:

• Gallstone ileus is an infrequent complication of biliary lithiasis, presenting as mechanical bowel obstruction.
• It typically arises from a bilioenteric fistula, where a gallstone causes blockage.
• Optimal surgical management remains debated due to limited case reports.

Purpose of the Study:

• To evaluate the outcomes of different surgical strategies for gallstone ileus.
• To identify the most effective treatment approach for this rare condition.

Main Methods:

• Retrospective, observational, descriptive study of patients with non-neoplastic bowel obstruction.
• Data collected included demographics, clinical presentation, imaging, surgical approach, and outcomes.
• Comparison between enterolithotomy alone versus more extensive procedures.

Main Results:

• Eleven cases (3.7%) of gallstone ileus were identified among 290 bowel obstructions.
• The majority of affected patients were elderly women with comorbidities.
• Enterolithotomy alone showed significantly lower complication rates (20% vs. 80%) and shorter postoperative stays (12.4 vs. 25.3 days).

Conclusions:

• Gallstone ileus is an uncommon cause of bowel obstruction, primarily seen in elderly females.
• Enterotomy with stone extraction alone is associated with superior outcomes compared to more invasive surgical techniques.