Gallstone ileus as a complication of cholecystolithiasis

Abstract

Biliary fistula and gallston ileus are rarely found. The diagnosis is difficult. Gallstone ileus requires urgent and appropriate surgical therapy. Enterolitotomy remains the gold standard of operative treatment for gallstone ileus, but additional procedures of one-stage cholecystectomy and repair of fistula are necessary. Some researchers advise first to resolve the gallstone ileus and then to perform the elective operation for gallstone disease in more ideal circumstances. Our case had clinical evidence of ileus, which was confirmed by radiological exam. Ultrasonographic examination performed before operation did not confirm the presence of gallbladder; it did not detect a large stone located in the intestine. The patient, a 75-year-old woman, was operated on. During the procedure it was shown that the second part of the duodenum was involved in a scar and displaced to the hepatic hilus. There was no gallbladder; it was probably destroyed by a long-lasting vesicoduodenal fistula. Cholangiography also did not detect the gallbladder. Biliary passage through the common bile duct was sufficient. The hole in the duodenum wall was sutured, and Kehr drain was inserted into the common bile duct. The gallstone was removed by incision of the intestine down to the obstruction. The postoperative period was complicated by a small suppuration of the laparotomy wound. Vesicoduodenal fistula present for a long time can lead to atrophy of the gallbladder. The one-stage procedure seems to be appropriate if biliary fistula and gallstone ileus are found.

Emergency ultrasound and gallstone ileus

“…In our patient, plain abdominal film disclosed signs of intestinal obstruction, as clinically suspected, but only E-US was able to identify the cause of obstruction. The lack of visualization of the gallbladder, as in our case, should not be considered as excluding the hypothesis of biliary ileus if previous biliary surgery is ruled out: a long-lasting asymptomatic bilioenteric fistula has been reported as a possible cause of gallbladder destruction or atrophy [9].…”

A Case of Gall Stone Ileus

“…In stable patients without any comorbidities, entorotomy with stone removal to relieve obstruction can be combined with cholecystectomy along with closure of fistula. [8] If the patient is having high risk factors then a two stage approach is preferred, enterotomy with stone extraction to relieve obstruction and followed by cholecystectomy and repair of fistula at a later date. In severely morbid patients just an enterolithotomy is performed, cholecystectomy is not done unless the patient complains of recurrent symptoms.…”

Tulžies akmenų sukeltas plonosios žarnos nepraeinamumas

“…Jie remiasi tuo, kad po enterolitotomijos šiems ligoniams išlieka pagrindinė liga (bilioenterinė fistulė). Tačiau toks radikalus požiūris į šios problemos sprendimą lemia ne tik didelį pooperacinių komplikacijų skaičių, bet ir didelį pooperacinį mirštamumą [8,9]. Tik labai gerai atrinktiems ligoniams, neturintiems sunkesnių gretutinių ligų, gali būti taikoma radikali vieno etapo operacija.…”