title: Gallstone ileus: One-stage surgery in a patient with intermittent obstruction.
abstract: Gallstone ileus, an uncommon complication of cholelithiasis, is described as a mechanical intestinal obstruction due to impaction of one or more large gallstones within the gastrointestinal tract. The clinical presentation is variable, depending on the site of obstruction, manifested as acute, intermittent or chronic episodes. A 51-year-old female patient was referred to our hospital with 3 events of intestinal obstruction during the previous 7 d. At admission, there were clinical signs of intestinal obstruction; abdominal film demonstrated dilated bowel loops, air-fluid levels and a vague image of a stone in the inferior left quadrant. Once stabilized, a laparotomy was performed. Surgical findings were distention of the jejunum and ileum proximal to a palpable stone in the ileum as well as gallstones and a cholecystoduodenal fistula in the gallbladder. An enterolithotomy, repair of the cholecystoduodenal fistula and cholecystectomy were performed. The postoperative course was uneventful. There is no uniform surgical procedure for this disease. When the patient is too ill or when biliary surgery is not advisable, an enterolithotomy is the best option. The one-stage procedure should be the offered to adequately stabilized patients when local and general conditions, such as good cardiorespiratory and metabolic reserve permit a more prolonged surgical procedure.
authors.affiliation: Carlos M Nuño-Guzmán, José Arróniz-Jáuregui, Pável A Moreno-Pérez, Édgar A Chávez-Solís, Nereida Esparza-Arias, Cuauhtémoc I Hernández-González, Department of General Surgery, Antiguo Hospital Civil de Guadalajara "Fray Antonio Alcalde", Calle Hospital No.278, Sector Hidalgo. C.P. 44280, Guadalajara, Jalisco, Mexico.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Nuño-Guzmán
authors.forename: José
authors.initials: J
authors.lastname: Arróniz-Jáuregui
authors.forename: Pável A
authors.initials: PA
authors.lastname: Moreno-Pérez
authors.forename: Edgar A
authors.initials: EA
authors.lastname: Chávez-Solís
authors.forename: Nereida
authors.initials: N
authors.lastname: Esparza-Arias
authors.forename: Cuauhtémoc I
authors.initials: CI
authors.lastname: Hernández-González