Gallstone Ileus: Review of Forty Cases

Forty cases of gallstone ileus are summarized in terms of incidence, physical findings and operative therapy. Vomiting with crampy abdominal pain was the chief complaint in the majority, and over half of the patients had a past history of cholecystitis or jaundice. Accuracy of preoperative diagnosis is increased if the physician has a high index of suspicion in the case of elderly patients with small‐bowel obstruction of obscure etiology. Gastrografin or barium upper‐gastrointestinal x‐ray examinations help to outline a cholecystoduodenal fistula or obstructive stone, especially in patients with a high small‐bowel obstruction. Discussion centers on three forms of surgical therapy: 1) enterotomy, 2) enterotomy with interval cholecystectomy and closure of the biliary‐enteric fistula, and 3) total one‐stage repair as an initial procedure. The data and observations confirm the opinion that enterotomy followed by an interval cholecystectomy, or selective total one‐stage repair of the cholecystoduodenal fistula with enterotomy, are the treatments of choice in patients with gallstone ileus.