title: Gallstone ileus: rare and still controversial.
abstract: BACKGROUND
  Gallstone ileus is a rare disease and accounts for about 1-3% of mechanic ileus of the small bowel, but for 25% of all small bowel obstructions in patients older than 65 years. Concomitant cardiorespiratory diseases or diabetes are frequent in older patients and responsible for the high mortality rate. The aim of the present study was to evaluate and discuss different surgical approaches and to analyze the clinical outcome.
  
  
  METHODS
  Four patients with a mean age of 72 years were treated for gallstone ileus at our hospital in the last 10 years. Patients history, operative strategy and their outcome is elucidated and a review of the recent literature is given.
  
  
  RESULTS
  In all patients the operative strategy was a one-stage procedure including enterolithotomy, cholecystectomy and closure of the fistula. The 30-day mortality rate was 25%.
  
  
  CONCLUSIONS
  One-stage procedure prevents from cholangitis, cholecystitis and recurrent ileus caused by further gallstones but bears the risk of enteric or biliary leakage after fistula closure. It should therefore be reserved for patients presenting in good general condition with a low degree of cholecystitis.
authors.affiliation: University Hospital Innsbruck, Department of General and Transplant Surgery, Tyrol, Austria. w.kirchmayr.dr@aon.at
authors.forename: Werner
authors.initials: W
authors.lastname: Kirchmayr
authors.forename: Gilbert
authors.initials: G
authors.lastname: Mühlmann
authors.forename: Mathias
authors.initials: M
authors.lastname: Zitt
authors.forename: Johannes
authors.initials: J
authors.lastname: Bodner
authors.forename: Helmut
authors.initials: H
authors.lastname: Weiss
authors.forename: Alexander
authors.initials: A
authors.lastname: Klaus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D005260:Female; D042882:Gallstones / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D045823:Ileus / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome