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Gallstone ileus: Surgical strategies and clinical outcome
Author(s) -
MUTHUKUMARASAMY Girivasan,
VENKATA Siva P,
SHAIKH Irshad A,
SOMANI Bhaskar K,
RAVINDRAN Rajan
Publication year - 2008
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/j.1751-2980.2008.00338.x
Subject(s) - medicine , gallstone ileus , outcome (game theory) , ileus , general surgery , postoperative ileus , intensive care medicine , surgery , fistula , mathematics , mathematical economics
OBJECTIVE: Gallstone ileus is a rare cause of intestinal obstruction affecting mainly the elderly. This study aimed to analyze the surgical treatments and outcome of the disease. METHODS: We present a retrospective study of 13 patients diagnosed with gallstone ileus from January 2000 to December 2005 in our hospital and a review of the published literature. RESULTS: Three men and 10 women participated in the study, with a mean age of 74.3 (range: 63–85). The mean duration of symptoms was 6 days (range 2–14). A pre operative diagnosis was made in 10 patients. The mean delay in diagnosis was 3.5 days (range 1–10). Ten patients had an enterolithotomy (E) and three patients had a one‐stage procedure comprising enterolithotomy, cholecystectomy and fistula repair (EC). There was no postoperative mortality in either group. The mean postoperative hospital stay for group E was 14 (range 6–31) days and for group EC was 19 (range: 5–28) days. Twelve patients were alive at the time of review. One patient from group E died of unrelated causes after three years. One patient in group E developed cholangitis but no surgical intervention was required on case note review over a mean postoperative period of 3.4 years. CONCLUSION: E alone is best suited in all elderly gallstone ileus patients with significant comorbidities. A one‐stage procedure (EC) should be reserved for young, fit and low risk patients.