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Gallstone Ileus in Octogenarians: Is Cholecystectomy Really Needed?
Nikolaos Koliakos1, Dimitrios Papaconstantinou1, Andrianos Serafeim Tzortzis2
13rd Department of Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Acta Medica (Hradec Kralove)
|March 21, 2023
Summary
Gallstone ileus, a rare complication of gallstones, causes intestinal obstruction. Surgical stone removal via enterotomy or gastrotomy is effective in octogenarians.
Area of Science:
- Gastroenterology
- Surgical Complications
- Geriatric Medicine
Background:
- Gallstone ileus is an uncommon but serious complication of gallstones (cholelithiasis).
- It occurs when a gallstone forms a fistula and obstructs the gastrointestinal tract.
- This condition disproportionately affects patients over 65, causing a significant portion of intestinal obstructions in this age group.
Purpose of the Study:
- To present the treatment approach for gallstone ileus in octogenarian patients.
- To evaluate the efficacy of surgical stone extraction in this elderly cohort.
Main Methods:
- Retrospective review of 6 octogenarian patients diagnosed with gallstone ileus.
- Surgical management involved enterotomy or gastrotomy for gallstone removal (lithotomy).
- No cholecystectomies were performed during the initial intervention.
Main Results:
- All 6 patients achieved resolution of intestinal obstruction through surgical gallstone extraction.
- Enterotomy or gastrotomy with lithotomy was the successful surgical approach in every case.
- No patient required cholecystectomy as part of the immediate treatment.
Conclusions:
- Surgical extraction of the gallstone via enterotomy or gastrotomy is a viable and effective treatment for gallstone ileus in octogenarians.
- Timely diagnosis and prompt surgical intervention are crucial for managing this condition in the elderly.
- Providers must be aware of the diagnostic and therapeutic strategies for gallstone ileus, particularly in older adults.
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