From the Research
Gallstone ileus should be managed with enterolithotomy alone, as it is associated with better outcomes than more invasive techniques, according to the most recent and highest quality study 1.
Diagnosis and Treatment
Gallstone ileus is a rare complication of cholelithiasis where a gallstone migrates through a bilioenteric fistula and causes mechanical bowel obstruction. The diagnosis typically involves Rigler's triad on imaging (pneumobilia, small bowel obstruction, and ectopic gallstone).
Surgical Management
Treatment generally requires surgical intervention to remove the obstructing stone. Several studies have compared the outcomes of different surgical techniques, including enterolithotomy alone, enterolithotomy with cholecystectomy and fistula repair, and bowel resection with or without fistula closure.
- Enterolithotomy alone is the most commonly performed procedure and is associated with lower mortality and morbidity rates compared to more invasive techniques 1.
- Enterolithotomy with cholecystectomy and fistula repair may be considered in select cases, but it is associated with higher mortality and morbidity rates 2, 1.
- Bowel resection with or without fistula closure is sometimes necessary, but it is also associated with higher complication rates and longer hospital stays 1.
Patient Outcomes
The overall 30-day postoperative morbidity and mortality rates for gallstone ileus are significant, with rates ranging from 35.4% to 6.67% respectively 2, 1.
- The most common complications include acute renal failure, superficial surgical site infection, and urinary tract infection 2, 1.
- Elderly patients, who represent the majority of cases, are at higher risk for complications and mortality due to underlying comorbidities and decreased physiological reserve 3, 4, 1.
Recommendations
Enterolithotomy alone is the recommended surgical technique for gallstone ileus, due to its association with better outcomes and lower mortality and morbidity rates 1. Minimally invasive techniques, such as laparoscopy or endoscopy, may be considered in select cases, but their use is still limited and requires further study 4. Understanding the latest research and outcomes data is essential for clinicians managing gallstone ileus, as it can inform treatment decisions and improve patient outcomes.