Gallstone ileus: analysis of eight cases and review of the literature

Abstract

Objective: We hereby analyzed a series of gallstone ileus cases operated on in our department starting from a Bouveret syndrome case.

Method: Retrospective analysis of all gallstone ileus cases who underwent surgery in our department during the last 26 years. We took into consideration diagnostic elements, time from admission to surgery, type of surgery and post-operative outcome.

Results: During this period 9,143 gallstones were deferred to surgery; 27 biliary-digestive fistulae were discovered during surgery; gallstone ileus complicated fistula in 8 patients. Gallstone ileus was exclusively present in elderly women with associated comorbidities. Diagnosis was suggested by clinical features of acute or incomplete intestinal obstruction; it was sustained by imagistic studies with different degrees of relevance. The average time from admission to surgery was 2.6 days. Surgical approach varied from simple enterolithotomy to additional fistula repair. The outcome was uneventful in most of the cases with only one exception.

Conclusions: gallstone ileus is a rare condition, occurring in elders with important comorbidities. The choice for surgical procedure depends on the obstructive syndrome's gravity and associated comorbidities; the type of intervention does not significantly influence post-operative morbidity and mortality rates.