A case of successful conservative management of gallstone ileus

Abstract

Gallstone ileus is an uncommon complication of cholelithiasis but an established cause of mechanical bowel obstruction in the elderly. Perforation of the small intestine proximal to the obstructing gallstone is rare, only a handful of cases having been reported. Management is mainly surgical, but conservative treatment is occasionally appropriate. We report the case of an 86-year-old female who presented with a clinical picture of bowel obstruction, proven to be related to gallstone ileus which resolved spontaneously. We discuss the role of conservative management for this condition.

Gallstone Ileus: Uncommon Presentation Followed by Less Common Spontaneous Resolution

“…The terminology of gallstone ileus refers to a mechanical obstruction caused by a lodged gallstone that has a sufficient diameter to cause an up-stream blockage. This is thought to be caused by impaction of a gallstone in the small bowel after passing through a biliary-enteric fistula [ 9 ]. This fistula may induce pneumobilia (in 34% of cases), bowel obstruction (70%) and an aberrantly located gallstone (35%) [ 10 ].…”

“…Approximately 75% of these fistulae are cholecystoduodenal, whereas only 10% to 20% are cholecystocolonic [ 12 ]. Approximately 40% to 50% of patients eventually diagnosed with gallstone ileus have a history of recent bouts of biliary colic, jaundice or acute cholecystitis [ 9 ].…”

“…Following this initial management, consideration of a deferred cholecystectomy and fistula repair is deliberated. A one-stage procedure (i.e., enterolithotomy and concurrent repair of fistula) has been associated with higher complication rates when compared to performing the two procedures consecutively, with high morbidity (61% vs 27%) and mortality rates (17% vs 12%) [ 9 ]. Recently, laparoscopic and laparoscopic-assisted enterolithotomy have been used for the treatment of gallstone ileus and found to be more beneficial over open surgery in selected patients [ 1 ].…”