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Cholecystocolonic fistula and gallstone obstruction

Case report and literature review

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Summary

Background

Mechanical obstruction secondary to colonic impact of a gallstone resulting from a direct cholecystocolonic fistula is a rare event. Although spontaneous resolution has been described, surgical or endoscopic procedures may be required to relieve the obstruction. The overall complication rate related to surgical treatment is relevant because of the acute presentation in elderly patients with multiple comorbidities and high operative risk.

Methods

An extensive literature search over the last two decades (1997–2017) was conducted. MEDLINE, Embase, and Cochrane databases were consulted. All the articles, case reports, and case series that described the management of colonic gallstone obstruction were included in this narrative review.

Results

In all, 41 cases of colonic gallstone ileus were included. The majority of the patients were successfully managed with an open (78%), endoscopic (14.6%), or laparoscopic approach (4.9%). Spontaneous resolution of the mechanical obstruction was described in one case (2.5%). The overall morbidity and mortality rates of the surgical-related procedures were 31% and 9.4%, respectively. In the endoscopic groups, there was no procedure-related morbidity and mortality.

Conclusion

An endoscopic approach may be a better therapeutic option in selected patients with colonic gallstone obstruction unfit for surgery.

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Author information

Authors and Affiliations

  1. Division of General and Emergency Surgery, University of Milan, Department of Biomedical Science for Health, Milan, Italy

    Alberto Aiolfi M.D., Chiara Ceriani M.D., Marco Sozzi M.D., Stefano Siboni M.D. &  Luigi Bonavina M.D.

  2. Piazza Edmondo Malan 1, 20097, San Donato Milanese MI, Italy

    Luigi Bonavina M.D.

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  1. Alberto Aiolfi M.D.
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  2. Chiara Ceriani M.D.
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  3. Marco Sozzi M.D.
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Correspondence to Luigi Bonavina M.D..

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Conflict of interest

A. Aiolfi, C. Ceriani, M. Sozzi, S. Siboni, and L. Bonavina declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This case report was exempt from the Institutional Review Board standards at University of Milan. Informed consent was obtained from all individual participants included in the study.

Additional information

Author contributions. A. Aiolfi, M. Sozzi, and S. Siboni carried out the literature search; A. Aiolfi, C. Ceriani, and L. Bonavina performed the study design; data collection was done by M. Sozzi and S. Siboni; A. Aiolfi and L. Bonavina analyzed the data; A. Aiolfi, M. Sozzi, S. Siboni, and L. Bonavina interpreted the data; A. Aiolfi and L. Bonavina wrote the manuscript; L. Bonavina critically reviewed the manuscript.

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Aiolfi, A., Ceriani, C., Sozzi, M. et al. Cholecystocolonic fistula and gallstone obstruction. Eur Surg 49, 254–260 (2017). https://doi.org/10.1007/s10353-017-0489-6

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