Gallstone ileus--clinical and therapeutic aspects.
Gallstone ileus represents a rare (0.3-0.5%), but serious complication of a common illness--the gallbladder lithiasis and the incidence of this fascinating disease has remained the same over the years. The main actual characteristics of this pathology are the age over 65, the female gender (men/women ratio 1/5:1:10--due to the high rate of vesicular lithiasis) and the under 50% diagnostic established preoperatively. The frequency of gallstone ileus recurrence is of 4,7-5%. In this article, we discuss the pathogenesis of this illness presenting all the mechanisms described in the medical literature. The Rigler triad found at the abdominal CT-scan generally established the diagnosis. Still, in 25% of the cases we have a misdiagnosis because of the underestimation of the size of the gallstone. Finally, the treatment of gallstone ileus has had major changes from the past. We described the endoscopic and laparoscopic approach, which represents the modern treatment of this disease. Despite these diagnostic and therapeutic possibilities, the mortality remains high and the common causes are associated comorbidities and late presentation to the physician.
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
M
M
Beuran
I
I
Ivanov
M D
MD
Venter
D015897:Comorbidity; D042882:Gallstones / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D045823:Ileus / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*
World J Surg. 2003 Apr;27(4):400-4
12658481
Sao Paulo Med J. 1995 Jan-Feb;113(1):721-5
8578083
Ann Surg. 1968 Mar;167(3):377-83
5644101
Br J Radiol. 1999 Aug;72(860):825-6
10624354
AJR Am J Roentgenol. 1978 Aug;131(2):219-22
97997
Aust N Z J Surg. 1994 Sep;64(9):650-2
8085986
J Dig Dis. 2008 Aug;9(3):156-61
18956594
Scand J Gastroenterol. 1987 Mar;22(2):253-6
3576131
Rev Gastroenterol Mex. 2005 Jan-Mar;70(1):44-9
16170962
Surg Endosc. 2002 Sep;16(9):1363
12073006
Ann Surg. 1955 Jul;142(1):52-65
14388611
Postgrad Med J. 1981 Jan;57(663):62-5
7279829
Gastrointest Endosc. 2007 Jan;65(1):173-5
17137860
Singapore Med J. 2004 Feb;45(2):69-72
14985844
Kurume Med J. 2008;55(1-2):29-33
18981682
World J Surg. 2007 Jun;31(6):1292-7
17436117
Ann Surg. 1966 Dec;164(6):1051-5
5926241
AJR Am J Roentgenol. 1979 Nov;133(5):921-3
115285
Radiology. 2002 Jul;224(1):9-23
12091657
Can Med Assoc J. 1937 Aug;37(2):167-8
20320710
AJR Am J Roentgenol. 2008 Jul;191(1):182-5
18562743
Br J Surg. 1950 Jul;38(149):21-5
15434313
World J Gastroenterol. 2005 Apr 14;11(14):2142-7
15810081
Gastroenterol Hepatol. 2001 Dec;24(10):489-94
11730617
Surg Laparosc Endosc Percutan Tech. 2003 Apr;13(2):83-7
12709612
J Postgrad Med. 2004 Jan-Mar;50(1):55-6
15048001
AJR Am J Roentgenol. 2005 Nov;185(5):1159-65
16247126
ANZ J Surg. 2005 Apr;75(4):234-8
15839973
Emerg Radiol. 2002 Jul;9(2):110-2
15290590
Inflamm Bowel Dis. 1998 May;4(2):89-94
9589295
Surg Clin North Am. 2008 Dec;88(6):1345-68, x
18992599
BMC Gastroenterol. 2002 Jun 18;2:15
12086587
Am J Dig Dis. 1974 Feb;19(2):109-12
4811164
Hepatogastroenterology. 2004 Jan-Feb;51(55):33-5
15011826
Surg Laparosc Endosc. 1993 Aug;3(4):310-4
8269250
Chirurg. 1995 Apr;66(4):443-5
7634963
HPB (Oxford). 2003;5(2):118-22
18332969
Ann R Coll Surg Engl. 1997 May;79(3):231-2
9196349
World J Surg. 2008 Oct;32(10):2237-43
18587614
J Am Coll Surg. 1998 Mar;186(3):370-1
9510270
J Hepatobiliary Pancreat Surg. 2003;10(4):299-302
14598150
Mt Sinai J Med. 2000 Mar;67(2):159-62
10747373
Cir Cir. 2005 Nov-Dec;73(6):443-8
16454956
Mt Sinai J Med. 2006 Dec;73(8):1132-4
17285212
Am Surg. 1994 Jun;60(6):441-6
8198337
Br J Surg. 2007 Jan;94(1):53-7
17058318
Ann Surg. 1942 May;115(5):721.b2-735
17858013
Chirurg. 1990 May;61(5):392-5
2364772
World J Gastroenterol. 2007 Feb 28;13(8):1295-8
17451220
J Laparoendosc Surg. 1994 Aug;4(4):265-72
7949386
Br J Radiol. 1998 Dec;71(852):1320-2
10319010
Ann Hepatol. 2008 Jul-Sep;7(3):258-9
18753996
AJR Am J Roentgenol. 2003 Apr;180(4):1033-5
12646450