Gallstone ileus: a single-center experience

Gallstone ileus (GSI) is a rare surgical emergency. Its diagnosis is challenging and frequently delayed. Moreover, there is no consensus regarding the optimal surgical approach. The primary point of debate is whether cholecystectomy and fistula repair should be performed and, if so, when. Several studies have suggested that omitting cholecystectomy and fistula repair may increase the risk of cholangitis, gallbladder cancer, and recurrent gallstone ileus. However, most of these data originate from studies conducted in the previous century and have not been supported by contemporary evidence. This study aimed to present our clinical experience with gallstone ileus, discuss diagnostic and therapeutic strategies, and review the relevant literature.

Medical records of 13 patients who underwent surgery for GSI between 2017 and 2022 at the Department of General Surgery, Kartal Dr. Lütfi Kirdar City Hospital, were retrospectively reviewed.

Of the patients, 69% were diagnosed with gallstone ileus at the time of admission, whereas 30.7% experienced a delayed diagnosis. The median time to surgery was 6 hours, and the median length of hospital stay was 6.5 days among patients diagnosed at admission. In contrast, patients with a delayed diagnosis had a median time to surgery of 126 hours and a median hospital stay of 14.5 days. Failure to establish the diagnosis at admission was associated with preoperative delays and prolonged hospitalization (p<0.05). Eleven patients underwent surgery aimed solely at relieving bowel obstruction, with fistula repair omitted. Two patients underwent additional cholecystectomy and fistula repair. During a mean follow-up period of 39.7 months, no cases of recurrent gallstone ileus, gallbladder cancer, or cholangitis were observed, despite omission of fistula repair in most patients.

GSI is a rare surgical emergency that is frequently associated with delayed diagnosis. Accurate diagnosis at presentation reduces preoperative delay and shortens hospital stay. Current evidence is insufficient to support routine cholecystectomy and fistula repair in all patients with GSI. The relationship between GSI and malignancy remains unclear. Surgical management should be individualized, and cholecystectomy with fistula repair should be considered when additional gallstones are present in the gallbladder.