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Management of gallstone ileus
Author(s) -
Pavlidis Theodoros E.,
Atmatzidis Konstantinos S.,
Papaziogas Basilios T.,
Papaziogas Thomas B.
Publication year - 2003
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-002-0806-7
Subject(s) - gallstone ileus , medicine , cholecystectomy , fistula , surgery , general surgery , laparotomy , mortality rate , dehiscence
Background/Purpose Gallstone ileus is an uncommon complication of cholelithiasis in the elderly with a high morbidity and mortality rate. This study aims to clarify the current surgical management. Methods/results In a retrospective survey over the past 11 years there were 9 patients with gallstone ileus, all elderly (mean age, 77 years), among 2242 cholecystectomies (0.4%) and 243 operated small intestinal obstructions (3.7%). Urgent laparotomy confirmed gallstone obstruction and a cholecystoduodenal (89%) or cholecystocolonic (11%) fistula. The operation included enterolithotomy alone (3 high‐risk cases) or plus fistula repair and cholecystectomy (6 cases). There were 3 postoperative complications including wound dehiscence, wound infection, and obstructive jaundice (morbidity, 37.5%) and 1 death due to myocardial infarction (mortality, 11%). On follow‐up (mean, 5 years), 6 patients with cholecystectomy (in 1 case it was performed 2 months after the initial operation) and 1 patient with enterolithotomy alone are well; there was 1 death from an unrelated cause after 1 year. Conclusion It seems that a one‐stage procedure (enterolithotomy plus fistula repair and cholecystectomy), when feasible, should be the first choice. Enterolithotomy alone should be reserved for only unstable and difficult cases.