Usefulness of CT-scan in the diagnosis and therapeutic approach of gallstone ileus: report of two surgically treated cases

Abstract

BackgroundGallstone ileus is a rare cause of gastrointestinal obstruction, more frequent in elderly patients, whose treatment is essentially surgical, although some para-surgical and mini-invasive possibilities exist, allowing the solution of such obstructive condition in a completely non-invasive way.DescriptionIn our study, after reporting two cases of biliary ileus managed by our surgical division, we will analyze the most suitable diagnostic procedures and the therapeutic approaches to this pathology.ConclusionsGallstone ileus is a quite rare pathology in population, but affects more frequently elderly people; The treatment of this disease is mainly surgical.

Gallstone ileus presenting as intussusception: A case report

“…Radiologic and clinical signs of SBO are a current indication for exploration, and so definitive pre-operative diagnosis of gallstone ileus is not required [5]. Although a single-stage procedure combining enterolithotomy, cholecystectomy and fistula repair is possible current evidence shows that simple enterolithotomy is the initial procedure of choice in elderly populations as single-stage procedures carry greater surgical risk [6], [7], [8].…”

Gallstone Ileus-A Case Report with Review of the Literature

“…GI is a rare complication of cholelithiasis, accounting for 1%-4% of all cases of bowel obstruction [3,4,5,6]. Appears more often in elderly people, with 70% of patients being over 65 years old [7] and usually females, as the ratio is 3.5:1 [8,9].…”

“…Spontaneous closure of the fistulas has been described in more than 50% of cases [3,4,13,23]. Prevalence of recurrent gallstone ileus is between 5%-9%4 and of biliary malignancy between 2%-6% [3].…”

A case of recurrent gallstone ileus: the fate of the residual gallstone remains unknown

“…Rigler's triad is the criteria used to determine gallstone ileus on a CT scan 10 11. The components of the triad are pneumobilia (figure 7) which suggests the presence of a biliary-enteric fistula, an ectopic gallstone and small bowel obstruction.…”

“…The components of the triad are pneumobilia (figure 7) which suggests the presence of a biliary-enteric fistula, an ectopic gallstone and small bowel obstruction. The majority of trusts now have access to a CT scanner, allowing for an early accurate diagnosis to be reached 9 11. Higher mortality rates were commonly due to the delay from symptom onset to surgical intervention, on average between 7 and 10 days 12.…”