Feasibility of Laparoscopic-Assisted Approach in Management of Gallstone Ileus

Abstract

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Laparoscopic management of gallstone ileus: A case report and literature review

“…The GI is secondary at the migration of a gallstone to the bowel through a fistula [7] , [9] , [10] , [13] , formed due a chronic inflammation in the gallbladder and the local pressure by the gallstone against, most frequently, the small bowel [8] , [9] , [13] . The cholecytoduodenal fistula is the most common, in 85% of the cases, followed by cholecystogastric, cholecystojejunal and cholecystocolonic [1] , [3] , [5] , [12] , [13] , [14] . There are other rarest cases, such a fistula originated directly from the biliary tract, with a higher rate of cholangitis [7] , the passage of gallstones through the ampulla of Vater followed by in-situ growth or inadvertent iatrogenic migration of gallstone during manipulation of gallbladder or ducts [1] , [3] , [13] , [14] .…”

“…To cause an obstruction the stone must be at least 2 cm in diameter [1] , [4] , [5] , [12] , [14] and the sites affected usually have significant narrowing in the bowel lumen; the most common are: terminal ileum and ileocecal valve (60–75%), proximal ileum and jejunum (20–40%), stomach (14%), sigmoid colon (4%) and duodenum (3–10%), the so-called Bouveret syndrome [2] , [3] , [6] , [7] , [12] , [13] , [14] . Also impaction at sites of strictures, such as Crohn's disease, diverticulitis or at the neck of Meckel's diverticulum, has been described [3] .…”

“…The diagnosis of GI is difficult, with a 43–73% made preoperative, and a median between admission and surgical intervention of 2–37 days, becoming an independent prognostic factor to the high mortality of this disease (7–30%) [3] , [5] , [7] , [9] , [12] , [13] . This is explained because the nonspecific presentation, lack of clear history of previous biliary disease and the typical radiological features being overlooked, if they are not supported by a clinical suspicion [2] , [5] , [10] , [12] .…”

“…The mortality and morbidity is still high nowadays, mostly given by the elderly population affected, late presentation from the onset of symptoms and the difficulty to make the diagnosis [1] , [2] , [3] , [8] , [12] , [13] .…”

“…The mainstay management is the open surgery, but in recent years the laparoscopy approach is summing cases; giving benefits of shorter hospital stay, faster recovery, less postoperative pain, among others [2] , [4] , [5] , [6] , [12] , [14] .…”