Comparison of Surgical Treatments of Gallstone Ileus: Preliminary Report

Doko, Marko; Zovak, Mario; Kopljar, Mario; Glavan, Elizabet; Ljubičić, Neven; Hochstädter, Hrvoje

doi:10.1007/s00268-002-6569-0

Cited by 136 publications

(125 citation statements)

References 8 publications

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“…22 ASA scores were similar between the two groups but operating times were significantly longer for the one-stage procedure. Logistic regression analysis showed that only urgent fistula repair was significantly associated with postoperative complications.…”

Section: Resultsmentioning

confidence: 78%

“…Logistic regression analysis showed that only urgent fistula repair was significantly associated with postoperative complications. 22 The authors concluded that enterolithotomy is the procedure of choice, with a one-stage procedure reserved for patients with acute cholecystitis, gallbladder gangrene or residual stones. 22 However, the study was not randomised and the selection process for each operative approach was not detailed; it is likely that there was selection bias for the two operative approaches.…”

Section: Resultsmentioning

confidence: 99%

“…22 The authors concluded that enterolithotomy is the procedure of choice, with a one-stage procedure reserved for patients with acute cholecystitis, gallbladder gangrene or residual stones. 22 However, the study was not randomised and the selection process for each operative approach was not detailed; it is likely that there was selection bias for the two operative approaches. Similar findings were reported by Rodriguez-Sanjuan et al 6 in a series of 25 patients.…”

Section: Resultsmentioning

confidence: 99%

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The operative management of gallstone ileus

Ravikumar

Williams

2010

annals

118

110

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Ann R Coll Surg Engl 2010; 92: 279-281 279The phenomenon of gallstone ileus was first described in 1654 by Dr Erasmus Bartholin, a Danish physician and mathematician, on a patient he examined at autopsy. 1 The pathogenesis of gallstone ileus involves adhesions forming between the inflamed gallbladder and an adjacent part of the gastrointestinal tract. Subsequently, large stones within the gallbladder cause pressure necrosis, resulting in formation of a cholecyst-enteric fistula, which allows gallstones direct access to the gut.2 Most fistulas involve the duodenum, but fistulas to the stomach and colon have been described. 3 In the last 350 years, gallstone ileus has remained an uncommon, but intriguing, entity. Whilst resolving the obstruction can usually be achieved by simple enterotomy and gallstone removal, the dilemma of how to deal with the fistula from the gallbladder to the intestine is less easy to resolve. Standard surgical texts have conflicting advice: The New Aird's surgical textbook advocates a one-stage procedure consisting of an enterotomy, closed transversely, and managing the fistula by either stapling or suturing across it, followed by cholecystectomy.2 However, it also states that in the presence of severe inflammation and adhesions, simply relieving obstruction by removal of the stone and leaving the fistula and gallbladder untouched may be more appropriate, particularly in an elderly patient.2 Similarly, Sabiston's textbook of surgery suggests a one-stage procedure to prevent attacks of recurrent cholecystitis and cholangitis, but also suggests that, in the event of a severe inflammatory process in the right upper quadrant and in an unstable patient, a second laparotomy should be performed to deal with the fistula. This short review looks at the evidence available on which to base surgical planning. Materials and MethodsPublished articles were identified from the medical literature Gallstone ileus is an uncommon entity, which accounts for 1-4% of all presentations to hospital with small bowel obstruction and for up to 25% of all cases in patients over 65 years of age. Despite medical advances over the last 350 years, gallstone ileus is still associated with high rates of morbidity and mortality. The management of gallstone ileus remains controversial. Whilst open surgery has been the mainstay of treatment, more recently other approaches have been employed, including laparoscopic surgery and lithotripsy. However, controversy persists primarily in relation to the extent of surgery performed. MATERIALS AND METHODS A literature review was performed in an attempt to discover the optimal surgical treatment of gallstone ileus, particularly the timing of biliary surgery. Published articles were identified from the medical literature by electronic searches of Pubmed and Ovid Medline databases, using the search terms 'gallstone ileus', 'gallstone/intestinal obstruction' and 'gallstone/bowel obstruction'. The related articles function of the search engines was also used to maximise the number of articl...

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Section: Resultsmentioning

confidence: 78%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The operative management of gallstone ileus

Ravikumar

Williams

2010

annals

118

110

View full text Add to dashboard Cite

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“…Plain abdominal X-ray could visualize air-fluid level in 77.8%, bowel loop dilatation in 88.9%, pneumobilia in 37%, air in gallbladder in 3.7% and ectopic stone in 33% of patients according to the clinical study conducted in Italy [11]. Helical CT may improve the diagnosis of gallstone ileus providing important information [12,13]. Abdominal ultrasound may also prove to be a useful tool for the diagnosis [14,15].…”

Section: Discussionmentioning

confidence: 99%

The Oldest Patient with Gallstone Ileus: Report of a Case and Review of 176 Cases in Japan

et al. 2008

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Summary:We report a 91-year-old woman presenting bowel obstruction due to impacted gallstone, who was the oldest patient which has been reported in Japanese scientific literature. The patient was referred to our hospital due to vomiting and abdominal pain. Computed tomography and abdominal X-ray showed dilated loops of small intestine associated with air-fluid levels, pneumobilia, and a calcified mass in the left iliac fossa. After the diagnosis of bowel obstruction due to gallstone was made, an enterotomy and lithotomy was performed under spinal anesthesia. The postoperative recovery was uneventful. We also reviewed 176 cases of gallstone ileus which were reported in the Japanese literature in the past 20 years. The retrospective analysis demonstrated that one-stage enterolithotomy alone may be acceptable as the first choice of operative treatment. The gallstone ileus is a rare, but important disease because urgent and appropriate surgical therapy is required.

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“…A spontaneous closure of the fistulous tract is observed in more than 50% of cases. 10,13 Recently, laparoscopy assisted enterolithotomy and endoscopic removal are becoming the preferred approaches for the treatment of GI. 14,16 Delayed diagnosis, concomitant comorbidity and advanced age are the causes of a high mortality rate (7.5-15%).…”

Section: -6mentioning

confidence: 99%