Gallstone ileus: a review

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Surgery

Background:

• Gallstone ileus is a significant complication of cholecystolithiasis.
• Surgical management of gallstone ileus presents challenges in approach selection.
• Cholecystoenteric fistula closure can be one-stage or two-stage, with trade-offs in mortality and fistula persistence.

Purpose of the Study:

• To review surgical approaches for gallstone ileus based on gallstone impaction site.
• To compare one-stage versus two-stage surgical operations for cholecystoenteric fistula closure.

Main Methods:

• Literature review of previous studies by the authors' group.
• Analysis of clinical reports on gallstone ileus management.
• Categorization of surgical strategies by gallstone impaction location (duodenum, small intestine, colon).

Main Results:

• One-stage operation is favorable for duodenal impaction due to fistula repair in the same surgical field.
• Two-stage operation may be suitable for small intestine impaction, potentially using laparoscopy, balancing low mortality with fistula closure.
• One-stage operation is recommended for colonic impaction to prevent fistula persistence and reflux cholangitis.

Conclusions:

• Surgical approach for gallstone ileus should be tailored to the impaction site.
• One-stage surgery is the preferred treatment for duodenal and colonic gallstone ileus.
• Two-stage surgery, possibly laparoscopic, is a viable option for small intestine gallstone ileus.