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Post-cholecystectomy Gallstone Ileus.

Jennie Meier1,2, Angela A Guzzetta1, Sergio Huerta1

  • 120115 Department of Surgery, VA North Texas Health Care System, Dallas, TX, USA.

The American Surgeon
|July 21, 2020
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Summary
This summary is machine-generated.

Postcholecystectomy gallstone ileus, a rare complication of gallstones, often results from lost stones during surgery causing bowel obstruction. Prompt stone retrieval after accidental spillage is crucial to prevent this condition.

Keywords:
cholecystectomyelderlygallstoneileus

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Area of Science:

  • Gastroenterology
  • Surgical Complications

Background:

  • Gallstone ileus is a rare complication of gallstones (cholelithiasis).
  • The classic pathophysiology involves a gallstone forming a fistula and obstructing the terminal ileum.
  • Exceptions to this pathway, including post-surgical cases, are increasingly recognized.

Purpose of the Study:

  • To conduct a systematic review of post-cholecystectomy gallstone ileus.
  • To identify and categorize the mechanisms leading to this complication.
  • To analyze patient demographics, diagnostic challenges, and outcomes.

Main Methods:

  • Systematic review of 49 reported cases of post-cholecystectomy gallstone ileus.
  • Analysis of patient data, including age, comorbidities, time to presentation, and diagnostic accuracy.
  • Identification and classification of etiological mechanisms.

Main Results:

  • Eight distinct mechanisms for post-cholecystectomy gallstone ileus were identified, with lost stones eroding into the bowel being most common.
  • The condition predominantly affects older females (64.0%, mean age 68.0 years) with comorbidities.
  • Diagnosis is frequently delayed (64%), with correct diagnosis on admission in only 37.5%; pneumobilia was noted in 29.0%.

Conclusions:

  • Post-cholecystectomy gallstone ileus is an uncommon but significant complication requiring surgical intervention.
  • Accidental intraoperative gallstone spillage necessitates retrieval to prevent future obstruction.
  • The incidence may rise with an aging population, highlighting the need for awareness and timely diagnosis.