Case series of gallstone ileus with one- or two-stage surgery

Abstract

Gallstone ileus is an uncommon cause of intestinal obstruction. It may present with typical symptoms of intestinal obstruction with or without biliary sepsis. Its management strategies vary depending on the patient and operative factors. Enterotomy and stone removal alone versus synchronous cholecystectomy and fistula disconnection at the same stage, often pose a debate among surgeons. The decision for operative strategies largely depends on the surgeon's experience, patient's physiology, and operative difficulties. As literature on gall stone ileus remains insufficient at a regional level, we report four cases of gallstone ileus managed with different approaches. Three patients were managed in a staged-manner, whereas one patient received a definitive procedure performed at index surgery. Clinical challenges and associated operative strategies are discussed. Findings of the current study were compared to those of the literature. The need for a definitive fistula disconnection and repair or cholecystectomy following stone removal in these patients was subsequently discussed.

Keywords: Fistula; Gallstone; Intestinal obstruction.

Fig. 1

(A) Computed tomography scan of the abdomen revealing an intraluminal hyperdense stone at the ileum (arrowhead) resulting in dilatation of the proximal bowel. (B) Removal of a single gallstone impacting the ileum via enterolithotomy.

Fig. 2

A hyperdense stone in the ileum (arrowhead) with small bowel dilatation shown in computed tomography scan of the abdomen.

Fig. 3

(A) Impacted gallstone at ileum with small bowel dilatation. (B) Enterotomy was done and gallstone was removed.

Fig. 4

(A) A large gallstone was found in the distal ileum (arrowhead) causing ileus. (B) Gallstone was removed.