A single centre case series of gallstone sigmoid ileus management

Farkas, Nicholas; Karthigan, Ravindran; Lewis, Trystan; Read, James; Farhat, Sami; Zaidi, Ahsan; West, Nicholas J.

doi:10.1016/j.ijscr.2017.09.009

Cited by 11 publications

(12 citation statements)

References 14 publications

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“…Patel documents an extended right hemicolectomy, primary anastomosis, proximal ileostomy and fistulectomy being undertaken [ 36 ]. Other documented surgery included the successful use of rectal examination with manual evacuation under anaesthesia [ 8 ]. Negative diagnostic laparotomy for gallstone ileus resulted in subsequent gallstone sigmoid ileus that eventually resolved spontaneously [ 8 ].…”

Section: Resultsmentioning

confidence: 99%

“…Other documented surgery included the successful use of rectal examination with manual evacuation under anaesthesia [ 8 ]. Negative diagnostic laparotomy for gallstone ileus resulted in subsequent gallstone sigmoid ileus that eventually resolved spontaneously [ 8 ]. One surgical procedure was not specified [ 15 ].…”

Section: Resultsmentioning

confidence: 99%

“…Given the fragility of such patients, the associated complications of complex surgery and anaesthesia may push already low reserves to their limits. Authors highlighted this along with multiple comorbidities and anaesthetic concerns regarding lengthy operations as major reasons for not undertaking fistula repair or cholecystectomy in the majority of patients [ 7 , 8 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Following the successful treatment of an 89 year old female patient with a novel surgical approach after failed trial with endoscopy at our center [ 7 ] and two subsequent cases [ 8 ] we felt it of benefit to other clinicians and patients to conduct an up-to-date literature review. The aim of this paper is to identify potential trends when managing such patients to help improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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A systematic review of gallstone sigmoid ileus management

Farkas

Kaur

Shanmuganandan

et al. 2018

Annals of Medicine and Surgery

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IntroductionGallstone sigmoid ileus is a rare although serious complication of cholelithiasis resulting in large bowel obstruction. The condition accounts for 4% of all gallstone ileus patients. There are no recognized management guidelines currently. Management strategies range from minimally invasive endoscopy and lithotripsy to substantial surgery. We aim to identify trends when managing patients with gallstone sigmoid ileus to help improve outcomes.MethodsLiterature searches of EMBASE, Medline and by hand were conducted. All English language papers published from 2000 to 2017(Oct) were included. The terms 'gallstone', 'sigmoid', 'colon', 'ileus', 'coleus' and 'large bowel obstruction' were used.Results38 papers included, male:female ratio was 8:30. Average age was 81.11 (SD ± 7.59). Average length of preceding symptoms was 5.31days (+/-SD3.16). 20/38 (59%) had diverticulosis. 89% of patients had significant comorbidities documented. 34/38 patients underwent computerized tomography. 31 stones were located within sigmoid colon, 4 at rectosigmoid junction and 2 within descending colon. Average impacted gallstone size was 4.14 cm (2.3–7 cm range). 23/38 (61%) patients' initial management was conservative or with endoscopy ± lithotripsy. Conservative management successfully treated 26% of patients. 28/38 (74%) patients ultimately underwent surgical intervention. 5/38 patients died post-operatively. Patients treated non-operatively had shorter hospital stays (4:12.3days) although not significant (p-value = 0.0056).ConclusionsThere is no management consensus from the literature. Current evidence highlights endoscopy and lithotripsy as practical firstline strategies. However, surgical intervention should not be delayed if non-operative measures fail or in emergency. Given the complexity of such patients, less invasive timesaving surgery appears practical, avoiding bowel resection and associated complications.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A systematic review of gallstone sigmoid ileus management

Farkas

Kaur

Shanmuganandan

et al. 2018

Annals of Medicine and Surgery

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“…Small and mid-sized stones are thought to pass through the entire colon, thus being easily expelled through stools; whereas gallstones over 2.5 cm in diameter may cause colonic obstruction at the sigmoid colon [ 2 , 6 , 16 , 20 , 21 ]. They usually occur secondary to a concomitant pathologic narrowing at that level, with diverticular disease being the most common cause [ 1 , 4 , 16 , 20 , 22 ]. Our patient had diverticular disease and a gallstone of 4 cm, predisposing it to impact at this point.…”

Section: Discussionmentioning

confidence: 99%

Gallstone ileus of the sigmoid colon caused by cholecystocolonic fistula: A case report

Mauricio

Eugenio

Quevedo-Fernandez

2018

Annals of Medicine and Surgery

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IntroductionA cholecystocolonic fistula (CCF) is a late complication following repeated episodes of chronic inflammation of the gallbladder in contact with the hepatic flexure, and it might cause a biliary ileus in the colon, causing an intestinal obstruction, and if left untreated, a life threatening disease.Presentation of casea 49-year-old female patient presented with abdominal pain and bowel obstruction due to a gallstone impaction on the sigmoid colon as consequence of a cholecystocolonic fistula. An enterolithotomy was performed, and the patient evolved favorably. She was discharged without complications on the 5th Postoperative day (POD).DiscussionClinical signs of CCF are usually minimal, and a preoperative diagnostic of CCF is rare, and it often presents with abdominal pain, nausea, vomiting, diarrhea, weight loss, and malabsorption. In the vast majority of patients presenting with CCF and biliary ileus, the stone is located within the sigmoid colon, accompanied with a concomitant disease at this point, with diverticulosis being the most common occurrence.ConclusionA cholecystocolonic fistula with a gallstone colonic ileus must be suspected in an elderly, and female, patient presenting with cholelithiasis and with intestinal obstruction. Treatment should not be delayed, and correction of the intestinal obstruction ought to be the basis of the treatment.

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Clinical and radiological diagnosis of gallstone ileus: a mini review

et al. 2017

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Gallstone ileus is a rare cause of bowel obstruction, which mainly affects the elderly population. The associated mortality is estimated to be up to 30%. The presentation of gallstone ileus is notoriously non-specific, and this often contributes to the delay in diagnosis. The diagnosis of gallstone ileus relies on a radiological approach, and herein we discuss the benefits and drawbacks of the use of different modalities of radiological imaging: plain abdominal films, computed tomography, magnetic resonance imaging, and ultrasound scanning. Based on our case experience and review of the literature, the authors conclude that although an effective first-line tool, plain abdominal films are not adequate for diagnosing gallstone ileus. In fact, the gold standard in an acutely unwell patient is computed tomography.

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A single centre case series of gallstone sigmoid ileus management

Cited by 11 publications

References 14 publications

A systematic review of gallstone sigmoid ileus management

A systematic review of gallstone sigmoid ileus management

Gallstone ileus of the sigmoid colon caused by cholecystocolonic fistula: A case report

Clinical and radiological diagnosis of gallstone ileus: a mini review

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