Disease spectrum and use of cholecystolithotomy in gallstone ileus transection.
BACKGROUND
Gallstone ileus is a heterogeneous and highly morbid condition that suffers from a lack of consensus regarding the timing and approach to management of the biliary tree and associated fistula.


METHODS
We report three cases that demonstrate the spectrum of gallstone ileus with classical examples of both Barnard's and Bouveret's syndromes. Clinical presentation, diagnostic imaging, surgical technique and outcome are discussed.


RESULTS
One patient with Barnard's syndrome presented with recurrent gallstone ileus. To minimize the risks of complex, definitive biliary surgery and avoid further recurrent episodes, a cholecystolithotomy was performed with effect. Two cases of Bouveret's syndrome were successfully managed with enterolithotomy/cholecystectomy and multivisceral resection respectively, thus highlighting the diverse nature of this disease and management options.


CONCLUSIONS
Following enterolithotomy, potentially morbid, definitive one-stage surgery in typically compromised, elderly patients needs to be weighed against the risk of recurrence and ongoing biliary pathology. We suggest the use of open cholecystolithotomy for the removal of residual gallstones when the patient is not suitable for definitive biliary surgery.
Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, University of Sydney, St. Leonards, Sydney, NSW 2065, Australia.
Nicholas E
NE
Williams
Justin S
JS
Gundara
Sophia
S
Roser
Jaswinder S
JS
Samra
D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D045823:Ileus / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D012008:Recurrence