A systematic review of gallstone sigmoid ileus management

Hehuwat

et al. 2019

NRJS

Introduction. Gallstone ileus is an uncommon mechanical bowel obstruction caused by a gallstone in the gastrointestinal tract which enters due to bile-enteric fistulae. This study aims to describe gallstone ileus and its management. Method. Data were retrospectively collected from medical records. Clinical manifestations, laboratory data, supporting radiographic examinations, treatment, postoperative care, and outcomes were collected. Results. We report two gallstone ileus cases at Cipto Mangunkusumo General Hospital, Jakarta which admitted in the last 20 years. The first case was a woman 33 years in 2002 and the second was man 45 years in 2017. Ileus was the main clinical symptoms. Gallstone ileus was diagnosed with preoperatively based on clinical and radiology findings. Laparotomy was performed and ileostomy for stones evacuation and cholecystectomy were performed without bile-enteric fistula repair. Large black stones were found at terminal ileum which made the obstruction. Conclusion. Gallstone ileus was an uncommon disease which can be treated and has a good prognosis. Plain abdominal x-ray has an important role in diagnosis and treatment approach.

Section: Discussionmentioning

confidence: 90%

“…9,10 Diarrhoea in the first case is unusually found. 6 However, it can be explained by bile acid overflow through bile-enteric fistula at the terminal ileum. 11,12 Mild hyponatremia in the first case related to vomiting and diarrhea.…”

Section: Discussionmentioning

confidence: 99%

Gallstone Ileus in Cipto Mangunkusumo General Hospital, Jakarta: A Case Series

Hehuwat

et al. 2019

NRJS

Journal of Surgical Case Reports

“…Gallstone ileus accounts for ~1–4% of intestinal obstruction cases, with the occlusion occurring mostly in the terminal ileum or the ileocecal valve [ 5 ]. This condition is associated with high morbidity and mortality [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Colonic biliary ileus is even scarcer, with the majority of cases reporting sigmoid obstruction. Farkas et al [ 5 ] have recently reported a wide array of surgical interventions that have been previously used to manage gallstone sigmoid ileus, including enterolithotomy, caecostomy, Hartmann’s procedure and bowel resection. Non-surgical measures such as endoscopy and lithotripsy have also been described [ 5 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Farkas et al [ 5 ] have recently reported a wide array of surgical interventions that have been previously used to manage gallstone sigmoid ileus, including enterolithotomy, caecostomy, Hartmann’s procedure and bowel resection. Non-surgical measures such as endoscopy and lithotripsy have also been described [ 5 , 7 ]. Their use with a colonic gallstone obstruction has been suggested as a less invasive option in properly selected patients [ 5 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cholecystocolonic fistula with a giant colonic gallstone: the mainstay of treatment in an acute setting

Hajjar

Létourneau

Henri

et al. 2018

A cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis with cholecystitis. Cholecystocolonic fistulas (CCFs) account for 8–26.5% of all CEFs. CCFs can cause colonic bleeding, obstruction or perforation, with such complications being mainly reported in the narrower sigmoid colon. Colonic biliary ileus, or obstruction due to the colonic gallstone impaction, is extremely rare in the proximal colon and its best management is yet to be elucidated. We present the case of a 73-year-old male patient with multiple comorbidities and previous abdominal surgeries who presented with hematochezia and intestinal obstructive symptoms. Imaging revealed a giant 5 × 7 cm2 gallstone in the proximal transverse colon. Laparotomy and stone extraction via colotomy were performed. Complicated proximal colonic gallstones are exceedingly rare with several operative and non-operative treatments already described. A time-saving surgery in a patient with serious comorbidities is reasonable when compared to a more extensive procedure including enterolithotomy, cholecystecomy and fistula closure.

Colonic gallstone ileus treated by a transanal ileus tube followed by spontaneous gallstone dislodgement: A case report

Takagi¹,

Kinoshita²,

Kawaguchi³

et al. 2022

DEN Open

A 71‐year‐old obese woman was referred to our hospital with lower left abdominal pain. Computed tomography showed a 46 mm elliptic calcification lodged in the sigmoid‐descending colon junction (SDJ), which had been detected 5 years prior but was not within the gall bladder at presentation. Therefore, we diagnosed colonic gallstone ileus with obstructive colitis caused by a gallstone. Colonoscopy revealed a smooth gallstone impacted at the sigmoid‐descending colon junction, which was not fixed and could be pushed proximally with the endoscope. Dislodgement of the stone was unsuccessful with both a large polypectomy snare and a retrieval basket. Considering the high risk of surgery, we chose a non‐surgical treatment strategy for obstructive colitis. Accordingly, a transanal ileus tube was placed to drain the proximal portion of the gallstone. The drainage of the colon by the ileus tube was satisfactory; the proximal colon was decompressed, ameliorating the obstructive colitis. Five days after tube placement, a colonoscopy revealed spontaneous passage of the gallstone into the rectum where it was finally removed. Cholecystocolonic fistula formation was confirmed by magnetic resonance imaging. We decided to surgically close the cholecystocolonic fistula to prevent future retrograde biliary infections. The surgery used a surgical stapler and was successful, with an uneventful postoperative course. Since radical surgical treatment of colonic gallstones and cholecystoenteric fistulas has a risk of postoperative morbidity and mortality, this case illustrates the importance of thoroughly considering nonsurgical interventions and surgeries for the safe treatment of colonic gallstone ileus.