Diagnosis and treatment: Gallstone ileus

Elabsi, M.; Amraoui, M.; Errougani, A.; Chkof, Moualay Rachid

doi:10.1016/j.dld.2006.10.004

Cited by 13 publications

(19 citation statements)

References 3 publications

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“…However, the stone may alternatively be found in the duodenum, where it will cause Bouveret s syndrome 6 , as well as in the jejunum 30 and colon 2.5 . Plain abdominal radiographs may reveal signs of small-bowel obstruction and concomitant aerobilia, which is also supportive of gallstone ileus 9 . However, the diagnosis of gallstone ileus is still frequently missed or delayed, and an accurate preoperative diagnosis is made in only 77 of cases 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, the majority of patients require surgery, with options including enterotomy and removal of the stones enterolithotomy , enterolithotomy plus cholecystectomy, and repair of the stula 6 . Most clinicians favor enterolithotomy alone, followed by cholecystectomy later, because of its lower morbidity and high spontaneous stula closure, up to 50 9 . Although it is a rare cause of bowel obstruction, gallstone ileus should be considered when treating cases of small bowel obstruction.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Gallstone Ileus

Umemoto

Shinmura

Shimada

et al. 2012

Showa Univ J Med Sci

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: A 57-year-old woman was admitted to our hospital with abdominal pain and vomiting. Her abdomen was distended, and obstructive bowel sounds were discovered on examination. Diffuse abdominal tenderness was present, but no palpable masses were apparent. Abdominal computed tomography confirmed a large gallstone obstructing the small bowel. Colonoscopy revealed a large gallstone lodged at the terminal ileum, which was subsequently fragmented using electronic hydraulic lithotripsy EHL . The patient has remained asymptomatic for over 3 years of follow-up after the EHL treatment.Here, we present this case of small intestinal obstruction caused by a large gallstone in the lower ileum.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Case of Gallstone Ileus

Umemoto

Shinmura

Shimada

et al. 2012

Showa Univ J Med Sci

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“…Gallstones with a diameter of more than 2-3 cm should be removed by enterolithotomy to prevent the gallstone ileus [3].…”

Section: Images In Surgerymentioning

confidence: 99%

“…Treatment options include: (a) enterolithotomy alone, (b) one stage procedure involving enterolithotomy, cholecystectomy with closure of the cholecystoduodenal fi stula, or (c) a two stage procedure consisting of enterolithotomy fi rst and the surgery of the biliary tract, at a later date [2,3]. Gallstones with a diameter of more than 2-3 cm should be removed by enterolithotomy to prevent the gallstone ileus [3].…”

Section: Images In Surgerymentioning

confidence: 99%

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Impacted gall stone ileus, seventeen of them!

Rodrigues

Shenoy

2008

Indian J Surg

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A 67-year-old male was referred with three days old symptoms of diffuse generalized pain abdomen with distension, but no vomiting. He had obstipation and also gave a history of occasional right upper quadrant pain, in the past. Clinical examination revealed small bowel obstruction and abdominal radiographs showed dilated small bowel loops with air fl uid levels (Fig. 1). As patient had not responded to conservative management of 3 days, he was subjected to an emergency laparotomy.At laparotomy, the small bowel was distended more than the large bowel. A hard object was felt at the ileocecal junction. An enterotomy revealed a large gall stone at this site. Seventeen stones were recovered from this enterotomy site (Fig. 2). On proximal examination, a cholecystoduodenal fi stula was found, for which a cholecystectomy with closure of the cholecystoduodenal fi stula was executed and the patient had an uneventful postoperative recovery. The patient has been followed up for seven months now with no postoperative complications.Gallstone ileus is a rare complication of cholecystolithiasis especially in the elderly age group, requiring emergency surgery. It is an uncommon cause of intestinal obstruction, accounting for 1-4% of mechanical small bowel obstructions and usually results from luminal impaction of one or more gallstones [1]. Of late, there have been more and more cases reported, likely as a result of a high index of suspicion and improved diagnostic imaging techniques. It is associated with a high mortality because of the advanced age of the patients, a delayed diagnosis and signifi cant concomitant medical illnesses [2]. The clinical symptoms and signs of gallstone ileus are mostly nonspecifi c, contributing to delay in diagnosis. Signs of a cholecystoduodenal fi stula are often absent on conventional radiological and ultrasonic methods, though a few show pneumobilia [3]. For several IMAGES IN SURGERY

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