Gallstone ileus of the sigmoid colon: a rare complication of cholelithiasis

Zingales, Francesca; Pizzolato, Elisa; Menegazzo, Marinella; Re, Chiara; Bardini, Romeo

doi:10.1007/s13304-011-0057-8

Cited by 9 publications

(8 citation statements)

References 9 publications

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“…Another had previously treated endometrial and breast cancer [ 11 ]. A third had endometrial cancer and inoperable oesophageal cancer [ 12 ] and another had treated uterine cancer [ 13 ]. Other co-morbid conditions are listed in Table 4 .…”

Section: Resultsmentioning

confidence: 99%

“…The latter included lithotripsy and endoscopic retrieval. In the single patient where conservative management was attempted, it was unsuccessful and the patient went on to have a sigmoid resection [ 12 ]. The team caring for this patient would have preferred to attempt a non-operative endoscopic approach prior to surgery but they did not have the expertise within their institution to do so.…”

Section: Resultsmentioning

confidence: 99%

“…Three patients underwent colonic resections of varying degrees. One had a sigmoid resection [ 12 ]. Valeri reports the patient undergoing a total colectomy, ileostomy formation and a contemporaneous cholecystectomy [ 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…The finding that many of the patients had delayed presentations with no resolution of symptoms supports this. Only one case utilised a solely conservative (non-invasive) approach that proved successful [ 12 ]. Our cohort represents only reported cases; consequently determining the effectiveness of this strategy is difficult given the paucity of data of conservatively managed patients.…”

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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Cholecystocolonic fistula and gallstone obstruction

et al. 2017

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Gallstone ileus: monocentric experience looking for the adequate approach

et al. 2017

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Common complications of biliary lithiasis are cholecystitis, bile duct lithiasis, and acute biliary pancreatitis. Gallstone ileus is uncommon complications often requiring surgical approach. It is a mechanical bowel obstruction caused by a biliary calculus usually originating from a bilioenteric fistula. Because of the limited number of reported cases, the optimal surgical method of treatment has been the subject of ongoing debate. A retrospective, observational, descriptive study was conduct on patients diagnosed with non-neoplastic bowel occlusion. For each case of gallstone ileus, the following variables were revised: personal and clinical data, mean time of onset of symptoms, length of pre- and postoperative stay, imaging studies, biochemical tests, site of the bilioenteric fistula and occlusion, surgical strategy, postoperative course, follow-up, and mortality. Of the 290 cases of non-neoplastic bowel obstruction from 2008 to 2015, 11 (3.7%) were due to gallstone ileus. The majority of patients were elderly women (F 9/M 2) with high average age (82.4; 76-88) and significant comorbidities. Five cases of small-bowel occlusions were treated with solely enterolithotomy. For the remaining six cases, digestive resection and cholecystectomy were performed. Complications rate (20 vs. 80%) and postoperative stay (12.4 vs. 25.3 days) were lower in the group of enterolithotomy with respect to the group treated with other procedures. In-hospital mortality was nil. Gallstone ileus is an uncommon bowel occlusion affecting mainly the elderly female population. Enterotomy with stone extraction alone is associated with better outcomes than more invasive techniques.

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Gallstone ileus of the sigmoid colon: a rare complication of cholelithiasis

Cited by 9 publications

References 9 publications

A systematic review of gallstone sigmoid ileus management

A systematic review of gallstone sigmoid ileus management

Cholecystocolonic fistula and gallstone obstruction

Gallstone ileus: monocentric experience looking for the adequate approach

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