Gallstone ileus as an unexpected complication of cholelithiasis: diagnostic difficulties and treatment.
BACKGROUND
Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. The aim of this study was to evaluate our experience with 12 gallstone ileus cases and discuss current opinion as reported in the literature.


METHODS
Data of 12 patients operated between January 1998 and January 2008 with gallstone ileus were retrospectively studied.


RESULTS
There were 12 cases (9 F, 75%; 3 M, 25%) with a mean age of 63.6 (50-80) years. Median duration of symptoms before admission to the hospital was 4.1 (1-15) days. Preoperative diagnosis was made in only five cases (41.6%). Enterolithotomy was done in nine cases (75%). Enterolithotomy and resection of the small intestine--required for decubital necrosis from the gallstone--was performed in one case (8.3%). In one case (8.3%), enterolithotomy was completed in one stage with cholecystectomy and closure of the fistula during acute surgery, and in another case (8.3%), enterolithotomy + primary suturing of the jejunal perforation was performed. There were two (16.6%) perioperative mortalities.


CONCLUSIONS
Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Gallstone ileus should be suspected in all cases admitted to the emergency service with acute intestinal obstruction with a history of cholelithiasis, especially in the elderly and females.
Yakan
Savaş
S
Izmir Bozyaka Training and Research Hospital, Izmir, Turkey. savasyakan@gmail.com
Engin
Omer
O
Tekeli
Tahsin
T
Calik
Bülent
B
Deneçli
Ali Galip
AG
Coker
Ahmet
A
Harman
Mustafa
M
D000368:Aged; D000369:Aged, 80 and over; D042883:Choledocholithiasis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002828:Choristoma; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging; D006801:Humans; D045823:Ileus / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed