[Gallstone ileus: plea for simultaneous treatment of obstruction and gallstone disease]

All patients with gallstone ileus admitted to our institution between 1985 and 1995, were retrospectively analysed, to determine, whether a one stage procedure (removal of impacted gallstone, fistula repair and cholecystectomy) is a more valid option than enterotomy. There were 10 patients (8 women, 2 men) in the study group (age range: 63-86 ans), representing 3.7% of small bowel obstruction and 1.4% of patients who underwent biliary surgery during the same period. Bowel occlusion was present in 8 patients and a correct preoperative diagnosis was made in only 2 cases (20%). Eight patients had a one-stage procedure, with no mortality but complications occurred in 2 cases. Enterotomy was the only surgical treatment in 2 cases, with no morbidity. During follow-up period, one patient died 3 years after enterotomy from a biliary complication. We believe that a one-step procedure, is a valid option and should be undertaken to prevent future recurrence, later biliary complications and reoperations in these elderly patients, who have serious concomitant diseases.