Gallstone Ileus: Rare and Still Controversial

Kirchmayr, W; Mühlmann, Gilbert; Zitt, Matthias; Bodner, Johannes; Weiß, Helmut; Alexander, Klaus

doi:10.1111/j.1445-2197.2005.03368.x

Cited by 87 publications

(113 citation statements)

References 28 publications

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“…Kallya Rajgopal Shenoy years, plain abdominal radiographs had remained the gold standard in the diagnosis of gallstone ileus with classical Rigler's triad of pneumobilia, presence of ectopic gallstone and mechanical bowel obstruction. However, Rigler's triad has been shown to be present in less than half of the patients with gallstone ileus, and there are recent reports advocating early use of other imaging modalities like abdominal ultrasound (US) and computed tomography (CT) scans for early diagnosis [4].…”

Section: Images In Surgerymentioning

confidence: 99%

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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Section: Images In Surgerymentioning

confidence: 99%

Impacted gall stone ileus, seventeen of them!

Rodrigues

Shenoy

2008

Indian J Surg

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“…In the literature, the presence of the Rigler triad on plain film radiography ranges from 17% to 87%. 12,13,18 Abdominal ultrasound can identify the presence of a cholecystoenteric fistula as well as a stone lodged in the small bowel, and when combined with abdominal radiography, can increase diagnostic sensitivity to 74%. 13,18,19 In a prospective study, Yu et al 20 showed computed tomography to have a sensitivity of 93%, a specificity of 100%, and a diagnostic accuracy of 99% for gallstone ileus.…”

Section: -11mentioning

confidence: 99%

“…Up to one-third of patients have no history of biliary colic symptomatology, and up to one-half have no history of gallbladder disease. 9,12,13 Symptoms are usually present for 3 to 5 days before presentation to a medical facility. [11][12][13][14][15][16] Once evaluated by a physician, the time to surgical treatment has a reported delay of another 3.7 days due to delay in diagnosis.…”

Section: -11mentioning

confidence: 99%

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Recurrent Gallstone Ileus

Hayes

2012

Clinical Medicine & Research

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“…CT-scan, performed after administration of intravenous, oral and rectal contrast and reconstructed in the coronal plane, shows a large gallstone (arrow) with central calcifi cation located in the proximal jejunum. Additionally, air in the biliary system (open arrow), and in the collapsed gallbladder (arrow head) can be observed rates, since most patients present acutely, diagnosis is frequently delayed and patients have pre-existing co-morbid medical conditions [2].…”

Section: Introductionmentioning

confidence: 99%

Gallstone ileus: correlation between computed tomography, double-balloon enteroscopy and intra-operative findings

Hartemink

Hepp

Bos

et al. 2010

Wien Klin Wochenschr

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Zusammenfassung. Der Gallenstein-Ileus ist eine seltene Ursache für eine Obstruktion des Dünndarms. Gefährdet sind vor allem ältere Patienten. Wir berichten über eine 88-jährige Patientin, die einen solchen Gallenstein-Ileus erlitt. Die Korrelation zwischen den Ergebnissen der Computer Tomographie und der Doppel-BallonEnteroskopie mit dem intra-operativem Befund wird ebenso wie mögli-che therapeutische Strategien diskutiert. Summary.Gallstone ileus is an uncommon cause of small bowel obstruction, aff ecting mainly elderly patients. We report a case of gallstone ileus in an 88-year old female patient. Th e correlation between computed tomography, double-balloon enteroscopy and intra-operative fi ndings is discussed, as well as treatment strategies.

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Gallstone Ileus: Rare and Still Controversial

Cited by 87 publications

References 28 publications

Impacted gall stone ileus, seventeen of them!

Impacted gall stone ileus, seventeen of them!

Recurrent Gallstone Ileus

Gallstone ileus: correlation between computed tomography, double-balloon enteroscopy and intra-operative findings

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