Gallstone ileus: diagnosis and management.
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.


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.
Ayantunde
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Professorial Unit of Surgery, Nottingham City Hospital, Nottingham, United Kingdom. biodunayantunde@yahoo.co.uk
Agrawal
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D000368:Aged; D000369:Aged, 80 and over; D001658:Biliary Fistula / Q000175:diagnosis / Q000601:surgery; D002761:Cholangitis / Q000209:etiology / Q000401:mortality; D002763:Cholecystectomy; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000601:surgery*; D045823:Ileus / Q000175:diagnosis / Q000601:surgery*; D007579:Jejunal Diseases / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography