Less is more: an outcome assessment of patients operated for gallstone ileus without fistula treatment

Abstract

HighlightsIn this study, 1.9% patients were diagnosed with gallstone ileus among those admitted for small bowel obstruction.85% of them underwent a conservative surgical approach mainly consisting in the enterolithotomy.Only one complication exceeded grade II in each group and no deaths were reported.Mean follow-up was 50 months and only one patient without fistula treatment had recurrent disease; no gallbladder cancer were identified.Enterolithotomy without fistula closure proved to be safe and effective for the management of gallstone ileus both on a short and long-term basis.

Stone in the distal jejunum presenting as small bowel obstruction: A case report

“…The standard surgical management of gallstone ileus is still a debate because of rarity of cases and lack of consensus guidelines. Various approaches to the management of gall stone ileus have been reported from minimally invasive shock-wave lithotripsy to major surgical exploration [ [9] , [10] , [11] ]. Surgical options include simple enterolithotomy, enterolithotomy and fistula closure with cholecystectomy, and bowel resection.…”

“…Surgical decision is largely dictated by the condition of the patient. Enterolithotomy is usually considered in elderly patients with multiple comorbidities while enterolithotomy, fistula closure, and cholecystectomy is a safer approach in young, haemodynamically stable patients [ 11 , 12 ]. In our cases, we repaired the fistula in a single-stage procedure and our patient did well postoperatively despite presenting in shock.…”

“…Few studies advocate two stage procedures in all patients with gallstone ileus owing to increased morbidity and mortality of one stage procedure [ 10 ]. One Italian study reports significantly lower morbidity after conservative surgery compared to definitive surgery (67% vs 29%) [ 11 ]. However, our patient did well after definitive surgery despite presenting in shock.…”

Gallstone Ileus in Cipto Mangunkusumo General Hospital, Jakarta: A Case Series

“…The incidence of surgical wound infection is increased in the enterolithotomy group with fistula repair compared to enterolithotomy only. 18,19 The other reason for not repairing the bileenteric fistula in both cases was due to the absence of big-sized stone in the biliary system preoperatively.…”

An emergency case of small bowel obstruction due to multiple gallstones in a limited resource setting

“…Therefore, upon the unspecific presentation of bowel obstruction with or without biliary symptoms, patients with risk factors of gallstones should be suspected for gallstone ileus. The standard management of gallstone ileus also remains disputed whether enterotomy alone or in combination with cholecystectomy and fistula closure is sufficient to prevent recurrence and further biliary complications [4,5]. In this report, we described a case of a middle age woman with small bowel mechanical obstruction due to gallstone ileus and presented the report in compliance to the SCARE 2018 guidelines [6].…”