Abdome agudo por obstrução por ileobiliar

Abstract

Gallstone ileus should be suspected in the elderly with SBO symptoms. Early diagnosis can reduce post-operative complications. Treatment is urgent laparotomy, and surgical treatment must be individualized for each case. The majority of patients in this study were treated with enterolithotomy, with cholecystectomy being performed later in two symptomatic patients.

Gallstone Ileus: An Improbable Cause of Mechanical Small Bowel Obstruction

“…The time-lapse between the first stage and the second stage ranges from four to six weeks after the first surgery [ 18 ]. The resection of an intestinal segment is indicated when there is an irreversible vascular compromise or bowel perforation [ 19 ].…”

Gallstones Ileus

“…The combination of abdominal and US radiography increased the sensitivity of the diagnosis of the biliary ileum to 74% [51]. The most frequent findings in Bouveret syndrome are gallstones in the gallbladder (53%), pneumobilia or gallbladder fistula (45%), gallstones in the duodenum (25%), dilated or distended stomach (15%), and a contracted gallbladder (13%) [31,41,43,52,53].…”

“…The main therapeutic goal is the relief of intestinal obstruction by extraction of gallstones. Hydroelectrolytic imbalances and metabolic disorders due to intestinal obstruction and preexisting comorbidities are common and require management before surgery [1,2,14,29,31,52,53,[66][67][68].…”

“…The possibility of recurrent cholecystitis and acute cholangitis [12,70] in patients with unrepaired gallbladder fistulas or retained gallbladder has been highlighted. Acute cholangitis has been reported in 11% of patients with cholecystoduodenal fistula and in 60% with gallbladder colic fistula [12,52,53,67,68]. With a one-stage procedure, further events related to gallstones are avoided [18].…”

“…According to several authors, enterolytictomy alone is the best option for most patients with biliary ileus. The one-step procedure should only be offered to highly selected patients with absolute indications for biliary surgery at the time of presentation and who have been adequately reanimated [6,7,13,21,29,31,52,53,67].…”