A rare case of gallstone ileus—the unanswered question

Abstract

Gallstone ileus is caused by an impaction of one or more gallstones within the gastrointestinal tract leading to mechanical intestinal obstruction. It is a rare complication of cholelithiasis and found in 2–3% of all cases associated with recurrent episodes of cholecystitis. This case study demonstrates an atypical presentation of gallstone ileus. A 57-year-old woman was presented with abdominal pain and vomiting without previous history of gallstone disease. The features of gallstone ileus are evident on computed tomography. She underwent an emergency laparotomy and enterotomy for the removal of impacting gallstones, followed by an interval cholecystectomy and cholecystoduodenal fistula closure. This case report aims to explore the proper surgical management of gallstone ileus. Unfortunately, the question of whether interval biliary surgery should be performed remains unanswered, and surgeons will continue to make the decision based on their clinical judgement.

Cholecystoduodenal fistula and gallstone ileus - diagnosis and surgical treatment

“…It most often occurs as a result of chronic cholecystitis. Inflammation of the gallbladder and surrounding structures leads to adhesions which in recurrent attacks of infection, due to the pressure of the stone on the wall of the gallbladder, leads to ischemia and the creation of a fistula between the gallbladder and the digestive tube, and the migration of the stone into the digestive tract and its further pathways [3,4]. The most common type of fistula is cholecystoduodenal, up to 70%, but less common, are cholecystojejunal, cholecystogastric fistula, cholecystocolonic.…”

“…It most often occurs as a result of stone migration through the resulting fistula between the gallbladder and the adhered portion of the gastrointestinal tract. Due to anatomical features, cholecystoduodenal fistula is the most common, but those with stomach, small and large intestine have also been reported [3].…”

Obstrucción intestinal por íleo biliar: reporte de un caso

“…Es causa de obstrucción de <4 % en menores de 65 y del 25 % en mayores de 65 años [3,5,8,10,11,14,15] . El IB es una entidad poco frecuente, pero con una elevada morbimortalidad, 5-10 veces mayor que el resto de las causas de obstrucción de intestino delgado [2,7] , oscilando entre el 12-27 % [6,8,10,13] , debido a los síntomas inespecíficos [6] , las comorbilidades de los pacientes en edad avanzada, así como por el retraso en su diagnóstico y tratamiento [5,8,10,11] .…”

“…Generalmente se presenta en pacientes femeninos mayores de 60 años con antecedentes de cólicos a repetición [4] . Representa solo del 1-4 % de las causas de obstrucción mecánica de intestino delgado [3,4,6,7] , sin embargo el riesgo aumenta con la edad [1] .…”

“…El desarrollo de FBD es relativamente raro (aproximadamente 2% en pacientes con colecistitis) [8] . La más frecuente es la colecisto-duodenal, siendo menos frecuente las que involucran al estómago y al colon [4,[7][8][9] .…”