Gallstone Ileus of the Colon: Leave No Stone Unturned

Salemans, P. B.; Vles, Georges; Fransen, Sofie; Vliegen, Roy F. A.; Sosef, Meindert N.

doi:10.1155/2013/359871

Cited by 10 publications

(14 citation statements)

References 13 publications

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“…The patient reported by Zielinksi whose large bowel obstruction resolved following lithotripsy required surgical management a day later, relating to concerns of concurrent biliary sepsis [ 30 ]. Salemans et al highlight concurrent surgical procedures over two days having attempted to defunction the patient initially only for clinical deterioration to warrant further intervention [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, five patients (13.1%) died post-procedure during their admission. Four [ 10 , 29 , 33 , 36 ] died following surgical management and one patient after endoscopic lithotripsy [ 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Salemans reports a patient who died in the intensive care unit after 1 day following a second laparotomy in as many days. Faecal peritonitis and a necrotic descending colon were identified during the second surgery [ 29 ]. The patient managed non-surgically with lithotripsy, died 7 days later in the intensive care unit from pneumonia [ 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Two others were managed similarly without diverticulosis. One patient was defunctioned to protect the primary closure of the colotomy whilst the other was due to an irretrievable gallstone [ 9 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some centers opted for extensive surgery as first line management or during the acute presentation with varying results [ 12 , 29 , 36 , 40 ]. The extensive surgery reported by Patel offers an insight into some of the surgery being undertaken, the operation included an extended right hemicolectomy, takedown of the cholecystocolic fistula, cholecystectomy and primary anastomosis.…”

Section: Discussionmentioning

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: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

A systematic review of gallstone sigmoid ileus management

Farkas

Kaur

Shanmuganandan

et al. 2018

Annals of Medicine and Surgery

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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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