Management of gallstone ileus.
OBJECTIVE
Gallstone ileus is an uncommon complication of cholelithiasis in the elderly with a high morbidity and mortality rate. This study aims to clarify the current surgical management.


METHODS
In a retrospective survey over the past 11 years there were 9 patients with gallstone ileus, all elderly (mean age, 77 years), among 2242 cholecystectomies (0.4%) and 243 operated small intestinal obstructions (3.7%). Urgent laparotomy confirmed gallstone obstruction and a cholecystoduodenal (89%) or cholecystocolonic (11%) fistula. The operation included enterolithotomy alone (3 high-risk cases) or plus fistula repair and cholecystectomy (6 cases). There were 3 postoperative complications including wound dehiscence, wound infection, and obstructive jaundice (morbidity, 37.5%) and 1 death due to myocardial infarction (mortality, 11%). On follow-up (mean, 5 years), 6 patients with cholecystectomy (in 1 case it was performed 2 months after the initial operation) and 1 patient with enterolithotomy alone are well; there was 1 death from an unrelated cause after 1 year.


CONCLUSIONS
It seems that a one-stage procedure (enterolithotomy plus fistula repair and cholecystectomy), when feasible, should be the first choice. Enterolithotomy alone should be reserved for only unstable and difficult cases.
Second Surgical Department of Medical Faculty of the Aristotles University of Thessaloniki, G. Gennimatas Hospital, Ethnikis Aminis 41, 546 35, Thessaloniki, Greece.
Theodoros E
TE
Pavlidis
Konstantinos S
KS
Atmatzidis
Basilios T
BT
Papaziogas
Thomas B
TB
Papaziogas
D000368:Aged; D000369:Aged, 80 and over; D041761:Cholecystolithiasis / Q000150:complications / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome