title: [Enterolithotomy and early cholecystectomy, an application of damage control surgery for patients with gallstone ileus].
abstract: BACKGROUND
  Recurrent gallstone ileus is an uncommon mechanical intestinal obstruction secondary to occlusion of the intestine by an intraluminal biliary calculus.
  
  
  METHODS
  Female, 75 years old, ischaemic heart disease (stent), arrived in our department complaining of abdominal pain and vomiting. Computed tomography showed gallstone ileus. The patient underwent an enterotomy with gallstone removal. Three months later, the patient came back with the same clinical symptoms and signs. A new computed tomography highlighted a gallstone ileus again. Enterolithotomy and gallstone removal, cholecystectomy and closure of cholecystoduodenal fistula were performed. The patient had a prolonged hospital stay due to the development of congestive heart failure. Case 2. Male, 71 years old, ischaemic heart disease and aortocoronary bypass, seen in our department complaining of vomiting. Computed tomography showed aerobilia and gallstone ileus. The patient underwent an urgent enterolithotomy. Seven months later, the patient came back with the same clinical symptoms and signs. Computed tomography showed a new gallstone ileus. An enterotomy and gallstone removal, cholecystectomy and closure of cholecystoduodenal fistula were performed. The patient died due to multi-organ failure in post-surgery period.
  
  
  CONCLUSIONS
  In the elderly patients with concomitant medical illnesses with the risk of a second laparotomy, it is justifiable to reconsider the definitive repair in the treatment of gallstone ileus. The enterolithotomy in acute phase followed by early cholecystectomy (4-8 weeks) may be a safe method for eliminating, not only the possibility of recurrent gallstone ileus, and probably the need for a second laparotomy, but also the exceptional possibility of developing a gallbladder carcinoma.
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitario de Canarias, La Laguna, Tenerife, España.
authors.forename: Jesica
authors.initials: J
authors.lastname: Martín-Pérez
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitario de Canarias, La Laguna, Tenerife, España. Electronic address: lucianodelgado1@gmail.com.
authors.forename: Luciano
authors.initials: L
authors.lastname: Delgado-Plasencia
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitario de Canarias, La Laguna, Tenerife, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bravo-Gutiérrez
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitario de Canarias, La Laguna, Tenerife, España.
authors.forename: Nieves
authors.initials: N
authors.lastname: Lorenzo-Rocha
authors.affiliation: Servicio de Medicina de Urgencias, Hospital Universitario de Canarias, La Laguna, Tenerife, España.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Burillo-Putze
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitario de Canarias, La Laguna, Tenerife, España.
authors.forename: Vicente
authors.initials: V
authors.lastname: Medina-Arana
mesh_terms: D000368:Aged; D002763:Cholecystectomy; D013505:Digestive System Surgical Procedures; D017809:Fatal Outcome; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000601:surgery*; D008297:Male
keywords: Cirugía de control de daño; Damage control surgery; Gallstone ileus; Intestinal obstruction; Obstrucción intestinal; Recurrent gallstone ileus; Íleo biliar; Íleo biliar recurrente