[Gallstone ileus as a cause of acute abdomen. Importance of early diagnosis for surgical treatment]

Indocyanine green fluorescence: A surgeon's tool for the surgical approach of gallstone ileus

Fluorescence cholangiography has been shown to improve biliary anatomy identification. A case of 60-year-old man with intestinal obstruction is reported, an entero-biliary fistula is suspected, and intravenous application of indocyanine green is decided, despite the great inflammatory process and fibrotic tissues found during the procedure, safe open cholecystectomy was achieved.

Cholecystogastric fistula in Bouveret syndrome: Case report and literature review

INTRODUCTION AND IMPORTANCE

Cholelithiasis is the benign bile pathology with major prevalence. A rare condition has been described, when a stone migrates through the duodenum causing small bowel obstruction (SBO), it's known as Bouveret syndrome, and it's attributed to almost 5% of SBO. Just 2% of the cases present with the migration of the stone through a fistula between gastric chamber and gallbladder, with limited reports in the literature.

CLINICAL FINDINGS

We present a case of an 87-year-old male with Bouveret syndrome and a cholecystogastric fistula with a stone in the gastric chamber who underwent laparoscopic gastrotomy to resolve the clinical case.

CONCLUSION

Bouveret syndrome remains to be a rare condition in benign bile pathology. Individualized treatment should be performed and multidisciplinary approach leads to improved outcomes for the patient.

Gallstone Ileus: An Improbable Cause of Mechanical Small Bowel Obstruction

Gallstone ileus (GI) is a rare complication of cholelithiasis and a rare cause of small bowel obstruction. It usually affects elderly women and the symptoms are nonspecific, both contributing to a delay in diagnosis and a high mortality rate. It is necessary to have a high suspicion index for diagnosis and abdominal CT is the gold standard imaging for the diagnosis. We present a case report of an 87-year-old man who presented to the ED with abdominal pain and vomiting for the last 20 days. A GI was diagnosed and he underwent enterolithotomy to remove the stone. Unfortunately, the patient died on the 13th postoperative day with multiorgan failure. The treatment and the time at which it is performed must be adapted to each patient.

[Gallstone ileus as a cause of abdominal pain in the elderly patient]

Gallstone ileus is a rare and potentially serious complication of cholelithiasis. It is defined as a mechanical intestinal obstruction secondary to the presence of a gallstone in the intestinal luz. The most frequent cause is impaction of the calculus in the ileum after passing through a bilioenteric fístula. It has a high morbidity and mortality rate, mainly due to the difficulty and delay in its diagnosis. A retrospective study is presented of 4 cases of gallstone ileus treated between 2013 and 2017 in the Hospital Nuestra Señora del Prado. An analysis was performed on the clinical characteristics, diagnostic tests, and surgical treatment.

Gallstone ileus with spontaneous evacuation: A case report

A 65-year-old man was referred to our hospital for abdominal pain. He had a history of enterotomy with stone extraction for gallstone ileus. On abdominal computed tomography, a stone measuring 32 × 28 mm lodged in the jejunum was identified. He was diagnosed with gallstone ileus and treated using a nasal ileus tube. Four days after admission, computed tomography showed that the stone had passed into the rectum. The gallstone was spontaneously evacuated on the same day. A fistula with the gallbladder was found in the duodenal bulb. The patient's condition improved, and he was discharged 9 days after admission.

Clinical and radiological diagnosis of gallstone ileus: a mini review

Gallstone ileus is a rare cause of bowel obstruction, which mainly affects the elderly population. The associated mortality is estimated to be up to 30%. The presentation of gallstone ileus is notoriously non-specific, and this often contributes to the delay in diagnosis. The diagnosis of gallstone ileus relies on a radiological approach, and herein we discuss the benefits and drawbacks of the use of different modalities of radiological imaging: plain abdominal films, computed tomography, magnetic resonance imaging, and ultrasound scanning. Based on our case experience and review of the literature, the authors conclude that although an effective first-line tool, plain abdominal films are not adequate for diagnosing gallstone ileus. In fact, the gold standard in an acutely unwell patient is computed tomography.

Laparoscopic Management of a Proximal Jejunal Gallstone Ileus with Patulous Ampulla and Choledochal Cyst-a Report of Unusual Presentation and a Review

Gallstone ileus is a diagnosis of rarity, and a proximal site of obstruction in a young patient is even rare. Of the three cases in our experience, we found two cases of gallstone ileus (GSI) with typical epidemiology and presentation, one had combination of multiple rare associations. We report such a case, suspected to have gallstone ileus on ultrasound and confirmed diagnosis on computed tomography. Presence of biliary-enteric fistula, old age, and obstructive features, as in typical cases, was a bigger asset for diagnosis, but it was difficult to entertain diagnosis of GSI in young girl in absence of a demonstrable biliary-enteric fistula, with uncommon association of choledochal cyst and sickle cell disease. A very surprising finding, dilated major papilla, could however explain the pathogenesis which has also been reported in the past. Although differential opinions regarding management exist, we decided to follow two-stage surgery as our institute protocol. A minimal access approach has been immensely helpful in accurate diagnosis, and expedative management with early recovery has been proven in the past studies which we agreed with our experience.

Gallstone ileus with jejunum perforation managed with laparoscopic-assisted surgery: rare case report and minimal invasive management

Gallstone ileus is an uncommon complication of cholelithiasis. Most patients affected by gallstone ileus are elderly and have multiple comorbidities. Symptoms are vague and insidious, which may delay the correct diagnosis for days. Here we are reporting an uncommon complication of gallstone ileus. We report on a 70-year-old man with small bowel obstruction at the jejunum due to an impacted stone, which led to necrosis and perforation of the proximal bowel wall. Laparoscope-assisted small bowel resection with enterolithotomy was used to successfully treat the patient's perforation and obstruction. His recovery was uneventful. Gallstone ileus commonly presents with bowel obstruction, but intestinal perforation occurs very rarely. A laparoscopic approach can provide both diagnostic and therapeutic roles in management.

[Gallstone ileus, experience in the Dr. Eduardo Liceaga General Hospital of Mexico]

BACKGROUND

Gallstone ileus is a rare cause of intestinal obstruction (1-4%). It results from the migration of a gallstone through a bilio-enteric fistula. Treatment begins with fluid therapy, followed by enterolithotomy, fistula closure, and cholecystectomy.

OBJECTIVES

To determine the clinical presentation in patients with gallstone ileus and subsequent medical -surgical management outcomes.

MATERIAL AND METHODS

A retrospective, observational, descriptive and transversal study was conducted on patients diagnosed with intestinal obstruction secondary to a gallstone ileus from May 2013 to October 2014. The following variables were recorded: age, sex, comorbidities, mean time of onset of symptoms, length of preoperative and postoperative stay, imaging studies, biochemical tests, type of surgical management, stone location and size, complications, mortality, and postoperative follow-up.

RESULTS

The study included 10 patients (male: female ratio 1:4), with a mean age of 61.9 years. The mean time of onset symptoms 15.4 days, and preoperative stay was 2days. On admission, 80% of patients had leukocytosis and neutrophilia, and 70% with renal failure. The most common surgical management was enterolithotomy with primary closure (50%), finding 80% of the stones in the terminal ileum. Recurrence was found in 2 cases. Mean postoperative hospital stay was 6.3 days. Mortality was 20%.

CONCLUSIONS

Gallstone ileus most commonly presented in women in the seventh decade of life, with intermittent bowel obstruction. On hospital admission, they presented with systemic inflammatory response, electrolyte imbalance and abnormal liver function tests. Initial treatment must include fluid-electrolyte replacement, and tomography scans must be made in all cases. In our experience, the best procedure is enterolithotomy and primary closure, which presented lower morbidity and mortality.

Karewsky syndrome: A case report and review of the literature

INTRODUCTION

Gallstone ileus can be a lethal disease, rarely suspected in the clinical scenario. It represents about 25% of all bowel obstruction cases in patients older than 65. There is a classification of gallstone ileus based on the onset time: acute, subacute and chronic (Karewsky syndrome). We describe the first reported case of chronic gallstone ileus.

CASE PRESENTATION

A 78-year-old female was admitted to the ER with a 15-day case of consistent bowel obstruction. The subject reported a five-year history of recurrent hospital admissions that resolved spontaneously after non-surgical management. Karewsky syndrome was diagnosed and managed with enterolithotomy. After five days of postoperative evolution the patient was discharged, and at six months follow up, no other hospital admission or relapse has been registered.

DISCUSSION

The gallstone ileus diagnosis demands a higher clinical suspicion, there is no biochemical marker, and an abdominal CT is ideal for imaging-based diagnosis. There is no consensus on the optimal surgical approach.

CONCLUSION

We describe the first case of Karewsky syndrome and a gastro-jejune and gastric-choledochus double fistula. We emphasize the importance of higher clinical suspicion for patients with bowel obstruction older than 65 years old and make evident that although there are not evidence-based guidelines for this treatment, enterolithotomy is a recommended approach.