Non-Operative Treatment for Gall-Stone Ileus - A Case Report

Abstract

Gall-stone intestinal obstruction (GSO) is an unusual form of mechanical obstruction and a rare complication of cholelithiasis. The treatment options are controversial, usually the management is surgical but associated with significant morbidity and mortality. A spontaneous evacuation of the gall-stone that had induced GSO is even more exceptional, only few reports being published up to date. We report the case of an 81-year-old female patient presenting GSO admitted to our department due to abdominal pain and vomiting. Computed tomography revealed pneumobilia, distention of the ileum and a calcified mass in the small bowel lumen. The diagnosis of GSO was established, but since the gall-stone was <25 mm and severe cardiorespiratory co-morbidities conservative treatment was initiated and spontaneous evacuation of the gall-stone was obtained. Diagnostic and management modalities of GSO as well as literature reviews are reported.

Spontaneous resolution of gallstone ileus followed by imaging: A case report and a literature review

“…Spontaneous resolution is reported in only 1.3% of cases of gallstones larger than 2-2.5 cm [7] . The literature reports that, in cases of spontaneous resolution, gallstone dimensions vary from 2 to 6 cm [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] . We were able to find only 13 previously published cases of GI with spontaneous resolution [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] and in the most of cases, the patients were women.…”

“…The literature reports that, in cases of spontaneous resolution, gallstone dimensions vary from 2 to 6 cm [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] . We were able to find only 13 previously published cases of GI with spontaneous resolution [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] and in the most of cases, the patients were women. The timing for the spontaneous resolution ranges from 16 hours to 7 days and the site of impaction was in the most of cases, the right iliac fossa [ 20 – 27 , 30 ].…”

Abdome agudo por obstrução por ileobiliar

“…In literature, the accuracy of preoperative diagnoses is from 13 to 48% 2,21 . For patients with severe associated illnesses and a high surgical risk, it is very risky to insist on non-operative treatment, monitoring the patient clinically and awaiting the elimination of the stone, although there are descriptions of this controversial conduct 25 . Some less invasive methods have been proposed for patients with a high surgical risk, depending on the location of the stone.…”