Developments in the Diagnosis and Management of Cholecystoenteric Fistula

Abdominal Pain and Hypotension in a 70-Year-Old Woman

“…1 An abdominal CT scan has a sensitivity of 93% and specificity of 100% for the diagnosis of gallstone ileus and is recommended for diagnostic imaging. 8 Surgical treatment is typically recommended for patients with gallstone ileus because spontaneous resolution of intestinal obstruction is rare. 1 Potential surgical procedures, performed using an open or laparoscopic approach, include extraction of the gallstone through an enterotomy (enterolithotomy) or enterolithotomy plus cholecystectomy and fistula closure performed in a single operation (1-step procedure) or in sequential operations (2-step procedure).…”

“…2,8,9 Although no randomized clinical trials currently exist to support a preferred surgical treatment, 7 enterolithotomy alone is the most commonly performed surgical procedure for gallstone ileus and has been associated with lower mortality rates and fewer immediate postoperative complications than alternative surgical options. 2,8,9 However, a 1-step procedure may be considered for patients at low risk of surgical complications to decrease the likelihood of gallstone recurrence, retrograde cholecystitis, and gallbladder cancer. 6 Recurrent gallstone ileus occurs in approximately 5% of patients treatedwithenterolithotomy,with85%ofrecurrencesoccurringwithin 6 months of surgery.…”

“…Surgical treatment is typically recommended for patients with gallstone ileus because spontaneous resolution of intestinal obstruction is rare . Potential surgical procedures, performed using an open or laparoscopic approach, include extraction of the gallstone through an enterotomy (enterolithotomy) or enterolithotomy plus cholecystectomy and fistula closure performed in a single operation (1-step procedure) or in sequential operations (2-step procedure) . Although no randomized clinical trials currently exist to support a preferred surgical treatment, enterolithotomy alone is the most commonly performed surgical procedure for gallstone ileus and has been associated with lower mortality rates and fewer immediate postoperative complications than alternative surgical options .…”

“…1 Potential surgical procedures, performed using an open or laparoscopic approach, include extraction of the gallstone through an enterotomy (enterolithotomy) or enterolithotomy plus cholecystectomy and fistula closure performed in a single operation (1-step procedure) or in sequential operations (2-step procedure). 2,8,9 Although no randomized clinical trials currently exist to support a preferred surgical treatment, 7 enterolithotomy alone is the most commonly performed surgical procedure for gallstone ileus and has been associated with lower mortality rates and fewer immediate postoperative complications than alternative surgical options. 2,8,9 However, a 1-step procedure may be considered for patients at low risk of surgical complications to decrease the likelihood of gallstone recurrence, retrograde cholecystitis, and gallbladder cancer.…”

“…Between 72% and 90% of patients with gallstone ileus are women, and approximately 50% of patients have no history of gallbladder disease . An abdominal CT scan has a sensitivity of 93% and specificity of 100% for the diagnosis of gallstone ileus and is recommended for diagnostic imaging …”