Difficult Management of Giant Gallstone Ileus of a Post-cardiopulmonary Resuscitation Patient: A Case Report

Abstract

Gallstone ileus is a rare form of mechanical intestinal obstruction. It is associated with high mortality and morbidity in the elderly population. The treatment of gallstone ileus includes more than one surgical option and it is appropriate to determine the surgical technique according to the general condition of the patient.In our case report, we present an 83-year-old patient who was admitted to the emergency room due to nausea and vomiting, was diagnosed with gallstone ileus, and had a cardiac arrest just before surgery. The patient management and the following surgical approach are also explained in detail.

Giant Gallstones – a Systematic Review

“…Gallstones are a major health concern, especially in affluent societies but majority of them (80%) are clinically "silent", and are treated expectantly [1][2]. In literature, there is no clear consensus over the precise dimension beyond which a gallstone may be labelled as large or giant but generally gallstones greater than 3 cm in any one dimension are termed as "large stones" whereas the stones larger than 5 cm are termed as "giant gallstones" [8][9][10]. In this review, as 5 cm was adopted by the authors as the threshold dimension for inclusion as giant stone, only one case was included from the series by Zoubi et al [12] and two cases with gallstones lesser than 5 cm (4.5 cm and 4.1 cm) were excluded.…”

“…"Large stones" are commonly defined as stones larger than 3 cm in any one dimension, and "giant stones", a rarer variant, have been generally defined as stones larger than 5 cm though, there is no clear consensus in literature over the measurements to be used to define a gallstone as "giant" or "large" [8][9][10].…”

Surgical Management of Cholecystoenteric and Cholecystocolonic Fistulas in Gallstone Ileus: Case Report

“…Author: Aistė Gulla, MD, PhD also report that the mortality after simple enterolithotomy is low, and it is associated with better results than more invasive techniques [9][10][11][12][13]. This approach could also proof beneficial in cases when CDF cannot be closed in a one-stage procedure e.g., in elderly patients with comorbidities and in risk of complications like cardiopulmonary resuscitation [14]. Therefore, we propose the enterolithotomy alone as the beneficial, conservative treatment of choice for CDF with a 'watch and wait' approach and possible two-stage procedure if the fistula persists.…”