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Augustin G, Bruketa T, Kunjko K, Romić I, Mikuš M, Vrbanić A, Tropea A. Colonic gallstone ileus: a systematic literature review with a diagnostic-therapeutic algorithm. Updates Surg 2023:10.1007/s13304-023-01537-0. [PMID: 37209317 DOI: 10.1007/s13304-023-01537-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/10/2023] [Indexed: 05/22/2023]
Abstract
Rare complication of gallstone disease is gallstone ileus. The common location is the small intestine, followed by the stomach. The rarest location is colonic gallstone ileus (CGI). To summarize and define the most appropriate diagnostic methods and therapeutic options for CGI based on the paucity of published data. Literature searches of English-, German-, Spanish-, Italian-, Japanese-, Dutch- and Portuguese language articles included and Italian-language articles using PubMed, EMBASE, Web of Science, The Cochrane Library, and Google Scholar. Additional studies were identified from the references of retrieved studies. 113 cases of CGI were recorded with a male to female patient ratio of 1:2.9. The average patient age was 77.7 years (range 45-95 years). The usual location of stone impaction was the sigmoid colon (85.8%), followed by a descending colon (6.6%), transverse colon (4.7%), rectum (1.9%), and lastly, ascending colon (0.9%). Gallstones ranged from 2 to 10 cm. The duration of symptoms was variable (1 day to 2 months), with commonly reported abdominal distension, obstipation, and vomiting; 85.2% of patients had previous biliary symptoms. Diverticular disease was present in 81.8% of patients. During the last 23 years, CT scan was the most common imaging method (91.5%), confirming the ectopic gallstone in 86.7% of cases, pneumobilia in 65.3%, and cholecytocolonic fistula in 68%. The treatment option included laparotomy with cololithotomy and primary closure (24.7%), laparotomy and cololithotomy with diverting stoma (14.2%), colonic resection with anastomosis (7.9%), colonic resection with a colostomy (12.4%), laparoscopy with cololithotomy with primary closure (2.6%), laparoscopy with cololithotomy with a colostomy (0.9%), colostomy without gallstone extraction (5.3%), endoscopic mechanical lithotripsy (success rate 41.1%), extracorporeal shock wave lithotripsy (1.8%). The cholecystectomy rate was 46.7%; during the initial procedure 25%, and as a separate procedure, 21.7%; 53.3% of patients had no cholecystectomy. The survival rate was 87%. CGI is the rarest presentation of gallstone ileus, mainly in women over 70 years of age, with gallstones over 2 cm, and predominantly in the sigmoid colon. Abdominal CT is diagnostic. Nonoperative treatment, particularly in subacute presentations, should be the first-line treatment. Laparotomy with cololithotomy or colonic resection is a standard procedure with favorable outcomes. There are no robust data on whether primary or delayed cholecystectomy is mandatory as a part of CGI management.
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Affiliation(s)
- Goran Augustin
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tomislav Bruketa
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Kristian Kunjko
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivan Romić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Gynecology and Obstetrics, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Adam Vrbanić
- Department of Gynecology and Obstetrics, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, University of Pittsburgh Medical Center, Palermo, Italy
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Mearelli F, Casarsa C, Peretti A, Spagnol F, Gennari AG, De Manzini N, Biolo G. Out of Place: Gallstone Ileus. Am J Med 2017; 130:1385-1387. [PMID: 28919024 DOI: 10.1016/j.amjmed.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Filippo Mearelli
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Chiara Casarsa
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alberto Peretti
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesca Spagnol
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Antonio Giulio Gennari
- Department of Radiology, University of Trieste, Strada di Fiume 447, IT-34149, Trieste, Italy
| | - Nicolò De Manzini
- Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Gianni Biolo
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Gallstone ileus: monocentric experience looking for the adequate approach. Updates Surg 2017; 70:503-511. [PMID: 29019098 DOI: 10.1007/s13304-017-0495-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 10/02/2017] [Indexed: 12/18/2022]
Abstract
Common complications of biliary lithiasis are cholecystitis, bile duct lithiasis, and acute biliary pancreatitis. Gallstone ileus is uncommon complications often requiring surgical approach. It is a mechanical bowel obstruction caused by a biliary calculus usually originating from a bilioenteric fistula. Because of the limited number of reported cases, the optimal surgical method of treatment has been the subject of ongoing debate. A retrospective, observational, descriptive study was conduct on patients diagnosed with non-neoplastic bowel occlusion. For each case of gallstone ileus, the following variables were revised: personal and clinical data, mean time of onset of symptoms, length of pre- and postoperative stay, imaging studies, biochemical tests, site of the bilioenteric fistula and occlusion, surgical strategy, postoperative course, follow-up, and mortality. Of the 290 cases of non-neoplastic bowel obstruction from 2008 to 2015, 11 (3.7%) were due to gallstone ileus. The majority of patients were elderly women (F 9/M 2) with high average age (82.4; 76-88) and significant comorbidities. Five cases of small-bowel occlusions were treated with solely enterolithotomy. For the remaining six cases, digestive resection and cholecystectomy were performed. Complications rate (20 vs. 80%) and postoperative stay (12.4 vs. 25.3 days) were lower in the group of enterolithotomy with respect to the group treated with other procedures. In-hospital mortality was nil. Gallstone ileus is an uncommon bowel occlusion affecting mainly the elderly female population. Enterotomy with stone extraction alone is associated with better outcomes than more invasive techniques.
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Gachabayov M, Mityushin P. An intriguing case of gallstone ileus after hepaticojejunostomy caused by a "stone on a suture". JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:80. [PMID: 27904625 PMCID: PMC5122189 DOI: 10.4103/1735-1995.189697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/29/2016] [Accepted: 05/31/2016] [Indexed: 11/17/2022]
Abstract
Gallstone ileus (GI) is a mechanical obstruction of small or large bowel caused by gallstone passed to the intestinal lumen through spontaneous or postoperative biliodigestive fistula. A 42-year-old female patient was admitted with the clinical presentation of small bowel obstruction. She underwent hepaticojejunostomy 4 years prior to admission for primary sclerosing cholangitis. Barium meal follows through revealed Rigler's triad. The patient underwent laparotomy which revealed GI. A “stone on a suture” was removed through enterotomy. Patients after cholecystectomy and hepaticojejunostomy can develop GI. Nonabsorbable suture used to create biliodigestive anastomosis can appear to become the frame of a “stone on a suture.”
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Affiliation(s)
- Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Petr Mityushin
- Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
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Miyasaka T, Yoshida H, Makino H, Watanabe M, Uchida E, Uchida E. Response of gallstone ileus to conservative therapy. J NIPPON MED SCH 2015; 81:388-91. [PMID: 25744483 DOI: 10.1272/jnms.81.388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report a case of cholelithiasis followed by gallstone ileus, documented with serial computed tomography (CT) scans, that responded to conservative therapy. An 80-year-old woman was admitted because of abdominal pain and vomiting. Six months previously, she had presented with abdominal pain and nausea of sudden onset. A CT scan showed thickening of the gallbladder wall and a gallbladder stone. She refused cholecystectomy, and the abdominal pain gradually improved in response to conservative treatment. On admission, plain abdominal radiographs showed obstruction of the proximal small bowel. A CT scan revealed disappearance of the gallbladder stone, fluid-filled bowel loops, and the presence in the small bowel of an impacted stone (major axis, 45 mm; minor axis, 23 mm). We diagnosed gallstone ileus. Because the gallstone was not large, we inserted a stomach tube and administered conservative treatment. One day after admission, CT showed that the impacted stone had migrated to the transverse colon. Four days after admission the impacted stone was not seen on plain abdominal radiography. Five days after admission, follow-up CT revealed pneumobilia but no impacted stone. Because the symptoms had improved the patient resumed oral intake of liquids The patient was discharged 14 days after admission and is doing well.
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Large Bowel Obstruction Due to a Big Gallstone Successfully Treated with Endoscopic Mechanical Lithotripsy. Case Rep Gastrointest Med 2015; 2015:798746. [PMID: 26137329 PMCID: PMC4468298 DOI: 10.1155/2015/798746] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/25/2015] [Indexed: 11/18/2022] Open
Abstract
Colonic gallstone ileus in an uncommon mechanical bowel obstruction caused by intraluminal impaction of one or more gallstones. The surgical management of gallstone ileus is complex and is potentially of high risk. There have been reports of gallstone extractions using various endoscopic modalities to relieve the obstruction. In this report we present the technique employed to successfully perform a mechanical lithotripsy and extraction of a large gallstone embedded in a sigmoid colon affected by diverticular stenosis. We passed through the stenosis with a 11.3 mm videoscope with 3.7 mm channel. A large lithotripsy extraction basket was used to catch and break up the stone and fragments were removed using the same basket. The patient was discharged asymptomatic three days after the procedure. Using appropriate devices mechanical lithotripsy is a safe and effective method to treat colonic obstruction and avoid surgery in the setting of gallstone ileus even in case of big stones.
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Lee HG, Hwang S, Joo YH, Cho YJ, Choi K. Gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after bile duct cancer surgery: a case report. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2015; 19:78-81. [PMID: 26155282 PMCID: PMC4494082 DOI: 10.14701/kjhbps.2015.19.2.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 05/28/2015] [Accepted: 05/30/2015] [Indexed: 12/26/2022]
Abstract
The diagnosis of gallstone ileus is occasionally challenging due to the variability of its presentation. We herein present a very rare case of gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after 10 years of bile duct cancer surgery. We describe the case of a 74-year-old Korean woman with obstructive jaundice, treated conservatively. She showed severely impaired liver function test and obstructive jaundice. The computed tomography (CT) scan led to a diagnosis of very rare type of gallstones ileus at the afferent jejunal loop. Since the clinical manifestation was improved, we decided to observe her closely. On the next follow-up CT scan, the gallstone disappeared with mild distension of the afferent bowel loop, implicating spontaneous passage of the gallstone. She recovered and returned to normal life after 10 days of initiation of clinical manifestations. We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size. The presence of narrow tract of intestine may facilitate the incidence of gallstone ileus. It appears to be the first report on this rare type of gallstone ileus inducing obstructive jaundice.
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Affiliation(s)
- Hyun Gu Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yo-Han Joo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu-Jeong Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyunghak Choi
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Pezzoli A, Maimone A, Fusetti N, Pizzo E. Gallstone ileus treated with non-surgical conservative methods: a case report. J Med Case Rep 2015; 9:15. [PMID: 25971789 PMCID: PMC4429341 DOI: 10.1186/1752-1947-9-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/08/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction The preoperative diagnosis of gallstone ileus is challenging due to the variability of its presentation, often resulting in late diagnosis. Controversy remains regarding the management of gallstone ileus; surgery is the standard treatment, but also less invasive approaches have proven to be successful. We present an unusual case of gallstone ileus and its conservative treatment. Case presentation We describe the case of a 49-year-old Caucasian woman with a bowel sub-occlusion, treated conservatively. The imaging technique (plain abdominal X-ray and computed tomography scan) led to a diagnosis of gallstones ileus. A surgical intervention was not performed. Instead, she underwent extracorporeal shock-wave lithotripsy to fragment the stones, mechanical intestinal dilatation for ileocolic stenosis and endoscopic removal of the gallstone. The presence of an apricot shell contributed to the bowel occlusion and was removed. The intervention was successful and without complications. Conclusions Given the variability of the gallstone ileus presentation, surgery could not be the only treatment for our patient. In our case report, we show that colonoscopy could be a non-invasive approach that allows for diagnosis and treatment at the same time. The available data do not show a higher rate of recurrent biliary disease in cases where this method has been used, therefore in select patients, a conservative treatment could be an effective solution.
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Affiliation(s)
- Alessandro Pezzoli
- Department of Gastroenterology and Endoscopy Unit, Sant'Anna University Hospital, v. A. Moro 8 203, 44124, Cona, Ferrara, Italy.
| | - Antonella Maimone
- Department of Gastroenterology and Endoscopy Unit, Sant'Anna University Hospital, v. A. Moro 8 203, 44124, Cona, Ferrara, Italy.
| | - Nadia Fusetti
- Department of Gastroenterology and Endoscopy Unit, Sant'Anna University Hospital, v. A. Moro 8 203, 44124, Cona, Ferrara, Italy.
| | - Elena Pizzo
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E7HB, UK.
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Keller M, Epp C, Meyenberger C, Sulz MC. Unspecific abdominal symptoms and pneumobilia: a rare case of gastrointestinal obstruction. Case Rep Gastroenterol 2014; 8:216-20. [PMID: 25076865 PMCID: PMC4105949 DOI: 10.1159/000364818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The case of a 77-year-old woman with symptoms of gastric outlet obstruction is presented. Transabdominal ultrasonography findings were suspicious of Bouveret's syndrome. Upper endoscopy confirmed this diagnosis. Bouveret's syndrome is a rare complication of gallstone disease caused by a bilioenteric fistula leading to gastric outlet obstruction by a gallstone and should be suspected in any patient who presents with pneumobilia without recent endoscopic retrograde cholangiopancreatography or biliary surgery.
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Affiliation(s)
- Martina Keller
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Carola Epp
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christa Meyenberger
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Michael Christian Sulz
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Waterland P, Khan FS, Durkin D. Large bowel obstruction due to gallstones: an endoscopic problem? BMJ Case Rep 2014; 2014:bcr-2013-201652. [PMID: 24390966 DOI: 10.1136/bcr-2013-201652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
A 73-year-old man was admitted with symptoms of large bowel obstruction. An emergency CT scan revealed pneumobilia and large bowel obstruction at the level of the rectosigmoid due to a 4×4 cm impacted gallstone. Flexible sigmoidoscopy confirmed the diagnosis but initial attempts to drag the stone into the rectum failed. An endoscopic mechanical lithotripter was employed to repeatedly fracture the gallstone into smaller fragments, which were passed spontaneously the next day. The patient made a complete recovery avoiding the potential dangers of surgery. This case report discusses cholecystoenteric fistula and a novel minimally invasive treatment for large bowel obstruction due to gallstones.
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Affiliation(s)
- Peter Waterland
- Department of General Surgery, Queens Hospital-Burton, Burton-upon-Trent, UK
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Gallstone ileus of the colon: leave no stone unturned. Case Rep Surg 2013; 2013:359871. [PMID: 23970992 PMCID: PMC3736546 DOI: 10.1155/2013/359871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/05/2013] [Indexed: 11/17/2022] Open
Abstract
A case of gallstone ileus of the colon with illustrative pictures is presented, making the physicians more aware of this rare entity. Furthermore, the use of imaging modalities for diagnosis and decision making in management strategy is discussed.
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Ganapathi S, Farooq AH, Ghosh S. Large bowel obstruction in an obese woman. Gastroenterology 2011; 141:1978, 2279. [PMID: 22033186 DOI: 10.1053/j.gastro.2010.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 11/15/2010] [Accepted: 11/22/2010] [Indexed: 12/02/2022]
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Heinzow HS, Meister T, Wessling J, Domschke W, Ullerich H. Ileal gallstone obstruction: Single-balloon enteroscopic removal. World J Gastrointest Endosc 2010; 2:321-4. [PMID: 21160765 PMCID: PMC2999031 DOI: 10.4253/wjge.v2.i9.321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 06/30/2010] [Accepted: 07/07/2010] [Indexed: 02/05/2023] Open
Abstract
Gallstone-induced ileus is a rare complication of cholelithiasis. Since localization of gallstones impacted in the small bowel, especially in the ileum, prevents access by conventional endoscopy in most cases, the mainstay of treatment remains surgical. Recent invention of double- and single-balloon enteroscopy has added much to the ability of imaging the small bowel and enables endoscopically directed therapy. Herein, for the first time, we report a successful endoscopic calculus removal via peroral single-balloon enteroscopy in an 81-year-old woman suffering from gallstone ileus of the ileum.
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Affiliation(s)
- Hauke Sebastian Heinzow
- Hauke Sebastian Heinzow, Tobias Meister, Wolfram Domschke, Hansjoerg Ullerich, Department of Medicine B, University of Muenster, Muenster D48149, Germany
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Zielinski MD, Ferreira LE, Baron TH. Successful endoscopic treatment of colonic gallstone ileus using electrohydraulic lithotripsy. World J Gastroenterol 2010; 16:1533-6. [PMID: 20333797 PMCID: PMC2846262 DOI: 10.3748/wjg.v16.i12.1533] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The surgical management of gallstone ileus is complex and potentially highly morbid. Initial management requires enterolithotomy and is generally followed by fistula resection at a later date. There have been reports of gallstone extraction using various endoscopic modalities to relieve the obstruction, however, to date, there has never been a published case of endoscopic stone extraction from the colon using electrohydraulic lithotripsy. In this report, we present the technique employed to successfully perform an electrohydraulic lithotripsy for removal of a large gallstone impacted in the sigmoid colon. A cavity was excavated in an obstructing 4.1 cm lamellated stone in the sigmoid colon using electrohydraulic lithotripsy. A screw stent retractor and stent extractor bored a larger lumen which allowed for guidewire advancement and stone fracture via serial pneumatic balloon dilatation. The stone fragments were removed. Electrohydraulic lithotripsy is a safe and effective method to treat colonic obstruction in the setting of gallstone ileus.
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Sadio A, Peixoto P, Pinho H. Small bowel obstruction: a hard diagnosis! Gastroenterology 2009; 137:e5-6. [PMID: 19879209 DOI: 10.1053/j.gastro.2009.04.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 04/03/2009] [Indexed: 12/02/2022]
Affiliation(s)
- Ana Sadio
- Gastroenterology Department, São Teotónio Hospital, Viseu, Portugal
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Abstract
BACKGROUND Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. It accounts for 1%-4% of mechanical bowel obstruction and is associated with high morbidity and mortality. We present our experience of gallstone ileus and discuss current opinion as reported in the literature. PATIENTS AND METHODS A retrospective review was performed of medical records of patients in our institution coded for gallstone ileus by the International Classification of Diseases (ICD K-563) coding system between January 1998 and December 2005. RESULTS There were 22 patients with mean age of 77 (58-92) years and a female to male ratio of 4.5:1. Most patients presented with abdominal pain and vomiting, with a median duration of symptoms of 3 (1-28) days. Preoperative diagnosis was made in 77% from a combination of plain x-ray, ultrasonography, and computed tomography (CT) scans; 86.4% of the patients belonged to ASA class of 3 or 4. Twenty patients underwent enterolithotomy alone, and two had one-stage procedure. The mean size of impacted stones was 3.6 (2.5-4.5) cm, with location in the terminal ileum in 17 and jejunum in 5 patients. There were 5 perioperative deaths and an episode of cholangitis occurring in one patient 18 months after enterolithotomy alone. CONCLUSIONS Gallstone ileus is a difficult clinical entity to diagnose. Unreserved use of imaging techniques can improve diagnostic accuracy and speed of therapeutic decision making. Management of gallstone ileus must be individualized. The one-stage procedure should be offered only to highly selected patients with good cardiorespiratory reserve and with absolute indications for biliary surgery at the time of presentation.
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Affiliation(s)
- A A Ayantunde
- Professorial Unit of Surgery, Nottingham City Hospital, Nottingham, United Kingdom.
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Chou JW, Hsu CH, Liao KF, Lai HC, Cheng KS, Peng CY, Yang MD, Chen YF. Gallstone ileus: Report of two cases and review of the literature. World J Gastroenterol 2007; 13:1295-8. [PMID: 17451220 PMCID: PMC4147014 DOI: 10.3748/wjg.v13.i8.1295] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gallstone ileus is a rare disease and accounts for 1%-4% of all cases of mechanical intestinal obstruction. It usually occurs in the elderly with a female predominance and may result in a high mortality rate. Its diagnosis is difficult and early diagnosis could reduce the mortality. Surgery remains the mainstay of treatment. We report two cases of gallstone ileus. The first was a 78-year old woman who had a 2-d history of vomiting and epigastralgia. Plain abdominal film suggested small bowel obstruction clinically attributed to adhesions. Later on, gallstone ileus was diagnosed by abdominal computed tomography (CT) based on the presence of pneumobilia, bowel obstruction, and an ectopic stone within the jejunum. She underwent emergent laparotomy with a one-stage procedure of enterolithotomy, cholecystectomy and fistula repair. The second case was a 76-year old man with a 1-wk history of epigastralgia. Plain abdominal film showed two round calcified stones in the right upper quadrant. Fistulography confirmed the presence of a cholecystoduodenal fistula and gallstone ileus was also diagnosed by abdominal CT. We attempted to remove the stones endoscopically, but failed leading to an emergent laparotomy and the same one-stage procedure as for the first case. The postoperative courses of the two cases were uneventful. Inspired by these 2 cases we reviewed the literature on the cause, diagnosis and treatment of gallstone ileus.
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Affiliation(s)
- Jen-Wei Chou
- Division of Gastroenterology, Department of Internal Medicine, China Medical University Hospital, No.2, Yuh-Der Road, North District, Taichung 40447, Taiwan, China
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Gemmel C, Weickert U, Eickhoff A, Schilling D, Riemann JF. Successful treatment of gallstone ileus (Bouveret's syndrome) by using extracorporal shock wave lithotripsy and argon plasma coagulation. Gastrointest Endosc 2007; 65:173-5. [PMID: 17137860 DOI: 10.1016/j.gie.2006.05.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Accepted: 05/22/2006] [Indexed: 12/17/2022]
Affiliation(s)
- Christian Gemmel
- Department of Gastroenterology, Klinikum Ludwigshafen, Academic Hospital of the University of Mainz, Ludwigshafen, Germany
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Abstract
BACKGROUND Gallstone ileus is a rare disease and accounts for about 1-3% of mechanic ileus of the small bowel, but for 25% of all small bowel obstructions in patients older than 65 years. Concomitant cardiorespiratory diseases or diabetes are frequent in older patients and responsible for the high mortality rate. The aim of the present study was to evaluate and discuss different surgical approaches and to analyze the clinical outcome. METHODS Four patients with a mean age of 72 years were treated for gallstone ileus at our hospital in the last 10 years. Patients history, operative strategy and their outcome is elucidated and a review of the recent literature is given. RESULTS In all patients the operative strategy was a one-stage procedure including enterolithotomy, cholecystectomy and closure of the fistula. The 30-day mortality rate was 25%. CONCLUSION One-stage procedure prevents from cholangitis, cholecystitis and recurrent ileus caused by further gallstones but bears the risk of enteric or biliary leakage after fistula closure. It should therefore be reserved for patients presenting in good general condition with a low degree of cholecystitis.
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Affiliation(s)
- Werner Kirchmayr
- University Hospital Innsbruck, Department of General and Transplant Surgery, Tyrol, Austria.
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21
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Abou-Saif A, Al-Kawas FH. Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Am J Gastroenterol 2002; 97:249-54. [PMID: 11866258 DOI: 10.1111/j.1572-0241.2002.05451.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gallstone is a common disease with a 10% prevalence in the United States and Western Europe. However, it is only symptomatic in 20-30% of patients, with biliary pain "colic" being the most common symptom. Complications of asymptomatic gallstone disease are generally rare, with an incidence of <1 %/yr. The most common complications of gallstone disease are acute cholecystitis, acute pancreatitis, ascending cholangitis, and gangrenous gallbladder. Less frequent complications include Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Mirizzi syndrome and cholecystocholedochal fistula are two manifestations of the same process that starts with impaction of a gallstone in the gallbladder neck that results in obstruction of the bile duct, causing jaundice. The gallstone may erode into the bile duct, causing cholecystocholedochal fistula. Gallstone ileus refers to small bowel obstruction resulting from the impaction of one or more gallstones after they have migrated through a cholecystoenteric fistula. An accurate diagnosis is essential to the management and prevention of further complications. A variety of imaging and endoscopic modalities are used to make the diagnosis once the condition is suspected clinically. Treatment should be tailored to each individual patient. Management choices include ERCP, lithotripsy (endoscopic or extracorporeal), and surgery. Prognosis is frequently related to early recognition, management of any comorbid conditions, and careful selection of treatment modalities.
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Affiliation(s)
- Alaa Abou-Saif
- Division of Gastroenterology, Georgetown University Medical Center, Washington, District of Columbia 20007, USA
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22
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Shenoy VN, Limbekar S, Long PB, Bashar AA. Relief of small bowel obstruction following colonoscopy in a case of gallstone ileus. J Clin Gastroenterol 2000; 30:326-8. [PMID: 10777200 DOI: 10.1097/00004836-200004000-00027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We describe a patient who presented with mechanical obstruction of the small bowel secondary to impaction of the ileocecal valve from a gallstone. The stone impaction of the ileocecal valve was confirmed by colonoscopy. Although the stone was disimpacted, it could not be trapped and extracted during colonoscopy. Thereafter, the patient's small bowel obstruction was relieved with no further intervention. Even though surgery is the gold standard for the management of gallstone ileus. colonoscopy can be useful in management of patients with gallstone ileus in whom surgery is contraindicated. A review of the literature is also presented.
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Affiliation(s)
- V N Shenoy
- Holzer Clinic/Holzer Medical Centre, Gallipolis, Ohio 45631, USA
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Abstract
In a 91-year-old female patient admitted with an ileus, ultrasound and computed tomography demonstrated the obstruction of the upper jejunum by a large gallstone. Due to concurrent diseases the patient was unfit for surgery. An attempt was made to remove the impacted stone endoscopically. After successful mobilization and fragmentation by mechanical lithotripsy the obstruction was cleared away. Since the patient improved considerably after this procedure, the gallbladder and the cholecystoduodenal fistula were left in place.
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Affiliation(s)
- H Lübbers
- Department of Internal Medicine, Municipal Clinic of Lüneburg, Lüneburg, Germany
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Ondrejka P, Balogh I, Bodnár A, Tóth CE, Forgács B, Sugár I, Faller J. Gastric outlet obstruction caused by gallstone: Bouveret’s syndrome. ACTA ACUST UNITED AC 1999. [DOI: 10.1007/bf02619885] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Affiliation(s)
- J D Wig
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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