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Review
. 2018 Jan 31:27:32-39.
doi: 10.1016/j.amsu.2018.01.004. eCollection 2018 Mar.

A systematic review of gallstone sigmoid ileus management

Nicholas Farkas  1 , Vasha Kaur  1 , Arun Shanmuganandan  1 , John Black  1 , Chantal Redon  1 , Adam E Frampton  1 , Nicholas West  1
Affiliations
Review

A systematic review of gallstone sigmoid ileus management

Nicholas Farkas et al. Ann Med Surg (Lond). .

Abstract

Introduction: Gallstone sigmoid ileus is a rare although serious complication of cholelithiasis resulting in large bowel obstruction. The condition accounts for 4% of all gallstone ileus patients. There are no recognized management guidelines currently. Management strategies range from minimally invasive endoscopy and lithotripsy to substantial surgery. We aim to identify trends when managing patients with gallstone sigmoid ileus to help improve outcomes.

Methods: Literature searches of EMBASE, Medline and by hand were conducted. All English language papers published from 2000 to 2017(Oct) were included. The terms 'gallstone', 'sigmoid', 'colon', 'ileus', 'coleus' and 'large bowel obstruction' were used.

Results: 38 papers included, male:female ratio was 8:30. Average age was 81.11 (SD ± 7.59). Average length of preceding symptoms was 5.31days (+/-SD3.16). 20/38 (59%) had diverticulosis. 89% of patients had significant comorbidities documented. 34/38 patients underwent computerized tomography. 31 stones were located within sigmoid colon, 4 at rectosigmoid junction and 2 within descending colon. Average impacted gallstone size was 4.14 cm (2.3-7 cm range). 23/38 (61%) patients' initial management was conservative or with endoscopy ± lithotripsy. Conservative management successfully treated 26% of patients. 28/38 (74%) patients ultimately underwent surgical intervention. 5/38 patients died post-operatively. Patients treated non-operatively had shorter hospital stays (4:12.3days) although not significant (p-value = 0.0056).

Conclusions: There is no management consensus from the literature. Current evidence highlights endoscopy and lithotripsy as practical firstline strategies. However, surgical intervention should not be delayed if non-operative measures fail or in emergency. Given the complexity of such patients, less invasive timesaving surgery appears practical, avoiding bowel resection and associated complications.

Keywords: Cholelithiasis; Emergency surgery; Gallstone ileus; Gallstone sigmoid ileus; Large bowel; Obstruction.

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Figures

Fig. 1
Fig. 1
Database literature search - PRISMA diagram.
Fig. 2
Fig. 2
Flow diagram of management strategies.
Fig. 3
Fig. 3
Graph of urgent and emergency surgical procedures.
See this image and copyright information in PMC

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