From the Research
Gallstone ileus occurs when a large gallstone erodes through the gallbladder wall into the adjacent small intestine, causing mechanical bowel obstruction, and the most effective treatment is surgical removal of the obstructing stone through enterotomy, as evidenced by the most recent study 1.
Causes of Gallstone Ileus
The causes of gallstone ileus can be attributed to the formation of a cholecystoenteric fistula, which is an abnormal connection between the gallbladder and the intestine, resulting from chronic inflammation caused by gallstones. This fistula allows the gallstone to enter the intestinal tract and become lodged, typically in the terminal ileum or ileocecal valve, blocking the passage of intestinal contents.
Diagnosis and Treatment
Diagnosis of gallstone ileus typically requires imaging studies such as abdominal X-rays or CT scans, which may show air in the biliary tree (pneumobilia) and signs of small bowel obstruction, along with an ectopic gallstone. Treatment usually involves surgical removal of the obstructing stone through enterotomy, as supported by the study 2, which highlights the importance of timely diagnosis and surgical management. The study 3 also emphasizes the need for prompt diagnosis and surgical intervention to achieve a favorable outcome.
Morbidity and Mortality
Gallstone ileus is associated with high morbidity and mortality rates, particularly in elderly patients, as reported in the study 4. The study found that the majority of patients were elderly women, and the most common complication was acute renal failure. The mortality rate was 6.67%, and the study concluded that enterotomy with stone extraction alone appears to be associated with better outcomes than more invasive techniques.
Recurrence
Recurrence of gallstone ileus is a management dilemma for operating surgeons, as reported in the study 1. The study highlights the need for a comprehensive solution, including fistula repair, to prevent recurrence. The study also emphasizes the importance of investigating various management strategies for recurrent gallstone ileus.
Key Points
- Gallstone ileus is a mechanical bowel obstruction caused by a gallstone entering the intestinal tract through a cholecystoenteric fistula.
- Diagnosis typically requires imaging studies such as abdominal X-rays or CT scans.
- Treatment usually involves surgical removal of the obstructing stone through enterotomy.
- Morbidity and mortality rates are high, particularly in elderly patients.
- Recurrence is a management dilemma, and a comprehensive solution, including fistula repair, may be necessary to prevent recurrence.