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Meta-Analysis
. 2021 Dec 2:2021:5539789.
doi: 10.1155/2021/5539789. eCollection 2021.

The Regularity of the Site of Impaction in Recurrent Gallstone Ileus: A Systematic Review and Meta-Analysis of Reported Cases

Nasser A N Alzerwi  1 , Bandar Idrees  2 , Saeed Alsareii  3 , Yaser Aldebasi  4 , Afnan Alsultan  5
Affiliations
Meta-Analysis

The Regularity of the Site of Impaction in Recurrent Gallstone Ileus: A Systematic Review and Meta-Analysis of Reported Cases

Nasser A N Alzerwi et al. Can J Gastroenterol Hepatol. .

Abstract

Objective: Due to the rarity of recurrent gallstone ileus (RGSI), its epidemiological and clinical features are elusive. With a focus on mortality and the site of impaction, this study consolidates the key clinical characteristics of index GSI (IGSI) and RGSI.

Methods: A meta-analysis of cases reported on RGSI was performed. Risk factors for mortality and site of impaction were examined, and a subgroup analysis was performed for age, sex, and site of impaction (jejunum, ileum, or others).

Results: In the final analysis, 50 (56 individual cases) studies were included. The paired data for the site of impaction was available for 45 patients. Women accounted for 87.3% of all RGSI cases included in the pooled analysis. The median age (interquartile range, IQR) of the patients was 70 (63-76) years, and the median time of recurrence (IQR) was 20.5 (8.5-95.5) days. The overall mortality rate was 11.8%, without correlation between the mortality rate and age, the time of recurrence, or the site of impaction. The region in which the stone was found in RGSI and IGSI was similar in most cases (p=0.002). Logistic regression also revealed a higher probability of stone impaction in the ileum in RGSI if it was the site of impaction in IGSI. In most cases, enterolithotomy was the preferred method.

Conclusions: A high index of suspicion for RGSI should be maintained for older women with a history of GSI. The region where the stone was impacted during IGSI should be investigated first in such patients.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram used for data extraction.
Figure 2
Figure 2
Completeness of data extraction.
Figure 3
Figure 3
Time of recurrence, (a) ISOI (p=0.73), (b) number of stones (p=0.27), (c) age groups in years (p=0.96), and (d) size of stones (p=0.18).
Figure 4
Figure 4
Impaction sites in RGSI patients, (a) with impaction in the jejunum during IGSI and (b) with impaction in the ileum during IGSI.
See this image and copyright information in PMC

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