World Journal of Surgery

, Volume 31, Issue 6, pp 1294–1299

Gallstone Ileus: Diagnosis and Management

Article

DOI: 10.1007/s00268-007-9011-9

Cite this article as:
Ayantunde, A.A. & Agrawal, A. World J Surg (2007) 31: 1294. doi:10.1007/s00268-007-9011-9

Abstract

Background

Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. It accounts for 1%–4% of mechanical bowel obstruction and is associated with high morbidity and mortality. We present our experience of gallstone ileus and discuss current opinion as reported in the literature.

Patients and Methods

A retrospective review was performed of medical records of patients in our institution coded for gallstone ileus by the International Classification of Diseases (ICD K-563) coding system between January 1998 and December 2005.

Results

There were 22 patients with mean age of 77 (58–92) years and a female to male ratio of 4.5:1. Most patients presented with abdominal pain and vomiting, with a median duration of symptoms of 3 (1–28) days. Preoperative diagnosis was made in 77% from a combination of plain x-ray, ultrasonography, and computed tomography (CT) scans; 86.4% of the patients belonged to ASA class of 3 or 4. Twenty patients underwent enterolithotomy alone, and two had one-stage procedure. The mean size of impacted stones was 3.6 (2.5–4.5) cm, with location in the terminal ileum in 17 and jejunum in 5 patients. There were 5 perioperative deaths and an episode of cholangitis occurring in one patient 18 months after enterolithotomy alone.

Conclusions

Gallstone ileus is a difficult clinical entity to diagnose. Unreserved use of imaging techniques can improve diagnostic accuracy and speed of therapeutic decision making. Management of gallstone ileus must be individualized. The one-stage procedure should be offered only to highly selected patients with good cardiorespiratory reserve and with absolute indications for biliary surgery at the time of presentation.

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  1. 1.Professorial Unit of SurgeryNottingham City HospitalNottinghamUnited Kingdom

Personalised recommendations