Gallstone causing gastric outlet obstruction 50 years after cholecystectomy

Chong, H.I.; Baird-Gunning, Eleni; Somasundaram, Shanmugam S; He, Mike

doi:10.1016/s0140-6736(19)31345-5

Cited by 3 publications

(2 citation statements)

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“…39 A case of gastric outlet obstruction (Bouveret's syndrome 9 ) in a patient who had a cholecystectomy 50 years prior was recently reported. 56 All of these patients were included individually in Table 1.…”

Section: Review Of the Literaturementioning

confidence: 99%

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Post-cholecystectomy Gallstone Ileus

Meier

Guzzetta

Huerta

2020

The American Surgeon™

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Gallstone ileus is an unusual complication of cholelithiasis. Classically, a stone is impacted at the terminal ileum originating from a cholecystoduodenal fistula. Exceptions to this pathophysiology have been noted at each step. In this systematic review, we document a comprehensive review of postcholecystectomy gallstone ileus inclusive of 49 separate cases and report 8 different mechanisms leading to this unusual complication. The most common mechanism is a lost stone during cholecystectomy that then erodes through the intestinal wall leading to bowel obstruction. Our review showed an older, female predominance (64.0%) at an average age of 68.0 years, patients typically had a burden of comorbidities. Delay in diagnosis was common (64% of cases) with the correct diagnosis made in 37.5% of patients during admission. Pneumobilia was commonly reported (29.0%). There was a wide range in the amount of time between cholecystectomy and gallstone ileus, from 10 days to 50 years (mean 12.4 years). Postcholecystectomy gallstone ileus is an unusual complication of cholelithiasis, which mandates surgery. Retrieval of stones should be undertaken if they are spilled during cholecystectomy. Owing to the increasing age of the American patient population, it is likely that a higher number of patients with this condition will be encountered.

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Section: Review Of the Literaturementioning

confidence: 99%

“…In 18 cases, the mechanism was unknown or not repor ted. 12,13,16,18,23,25,26,29,30,32,36,39,43,47,49,[54][55][56]…”

Section: Mechanismmentioning

confidence: 99%

Post-cholecystectomy Gallstone Ileus

Meier

Guzzetta

Huerta

2020

The American Surgeon™

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Current evidence on the diagnosis and management of spilled gallstones after laparoscopic cholecystectomy

Aziz,

Kwon,

Lee

et al. 2024

Journal of Gastrointestinal Surgery

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Post hoc validation of a tool that accurately predicts the outcome of endoscopic therapy in Bouveret syndrome

Swift

Ong

Zhou

et al. 2021

Gastroenterology Report

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Background Bouveret syndrome is characterized by gallstone impaction in the upper gastrointestinal tract causing gastric outlet obstruction. In Bouveret syndrome, endoscopic gallstone removal can avert the need for surgery. However, in cases in which endoscopic therapy is unlikely to succeed, endoscopic attempts delay definitive treatment and compound patient risks. We previously developed a model that predicts endoscopic outcomes from data derived through a systematic review. This tool uses gallstone length, site of impaction, and the number of planned methods of lithotripsy to predict the likelihood of endoscopic success with an accuracy of 81.0%. This study aimed to evaluate our tool performance in an independent, non-training data set and assess endoscopic and surgical outcomes. Methods Systematic searches of the PubMed, Scopus, and Cochrane databases were performed for articles published between 16 April 2018 and 1 June 2021. The data reported after our previous study were harvested and inputted into the tool to evaluate their ability to accurately predict outcomes when compared with actual outcomes. Results Newly collated data in fields of interest showed no significant statistical differences compared with previous training data sets. Endoscopic therapy was successful in 41.9% of cases. Gallstones of ≤4 cm had a higher chance of successful endoscopic intervention (odds ratio 6.7, 95% confidence interval 1.7–25.8, P < 0.01). Complications of surgery were reported in 29.5%; there was one fatality reported. Post hoc evaluation of our predictive tool demonstrated an AUROC score of 0.80. Conclusions We have demonstrated in an independent data set that the tool can be used to accurately predict outcomes of endoscopic therapy. Patients in whom endoscopic therapy is most likely to fail should be offered an early surgical opinion.

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Gallstone causing gastric outlet obstruction 50 years after cholecystectomy

Cited by 3 publications

References 0 publications

Post-cholecystectomy Gallstone Ileus

Post-cholecystectomy Gallstone Ileus

Current evidence on the diagnosis and management of spilled gallstones after laparoscopic cholecystectomy

Post hoc validation of a tool that accurately predicts the outcome of endoscopic therapy in Bouveret syndrome

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