Twice recurrent gallstone ileus: a case report

Abstract

IntroductionGallstone ileus is a rare cause of bowel obstruction and results from the passage of gallstones into the bowel.Case presentationWe present the case of an 83-year-old Caucasian woman who had three episodes of gallstone ileus, each of which was managed with simple enterotomy. This sequence is one of the first reported in the medical literature and may be seen to challenge the traditional surgical approach of enterotomy alone.ConclusionsThe available evidence comparing enterotomy alone with combined enterotomy, cholecystectomy, and fistula closure in the management of gallstone ileus is reviewed. Neither approach is clearly identified as superior, but available series suggest that simple enterotomy may be safer than a combined approach and does not result in a higher rate of recurrent biliary disease.

Gallstone ileus: a rare type of intestinal obstruction in Ghana

“…If the fistula does not close, there remains about 22% risk of developing recurrent gallstone ileus in the future. 11,17 CT scan is superior to plain X-rays in the diagnosis of gallstone ileus. 2 Contrast enhanced CT scan increases the sensitivity and specificity of diagnosis.…”

“…10 Cholecystectomy and repair of fistula is done as a two-stage procedure in order to avoid mortality and reduce morbidity in the elderly with significant co-morbidities who are mostly affected. 11 We report a case of gallstone ileus that was diagnosed during surgery and highlight all relevant clinical information that were present in this case to draw the attention of clinicians to this uncommon condition that could appear in our practice.…”

Minilaparotomy for biliary ileus: A different approach

“…There are discussion about one-stage procedure (enterolithotomy, cholecystectomy and fistula repair) versus enterolithotomy alone [8][9][10][11] .…”

Abdome agudo por obstrução por ileobiliar

“…Many authors argue that the risk of recurrence of BI, from 5% to 17%, is high, so there is need for definitive treatment of the fistula 13,21,28,29 . Other complications arising from maintaining the cholecystoduodenal fistula center on the risk of the patient having intestinal malabsorption, weight loss, recurrent pain, recurrent cholecystitis, cholangitis and gallbladder cancer 3,14,28 . In a 1965 study, an incidence of 15% of gallbladder cancer in patients with BI was noted, compared to only 0.8% in patients who underwent elective cholecystectomy 28 .…”

“…Other complications arising from maintaining the cholecystoduodenal fistula center on the risk of the patient having intestinal malabsorption, weight loss, recurrent pain, recurrent cholecystitis, cholangitis and gallbladder cancer 3,14,28 . In a 1965 study, an incidence of 15% of gallbladder cancer in patients with BI was noted, compared to only 0.8% in patients who underwent elective cholecystectomy 28 . Some authors have reported spontaneous closure of the fistula and argue that, if the bile duct were open and there were no residual calcification, the cholecystoduodenal fistula could close spontaneously 5,19,21 .…”