From the Research
Gallstone ileus should be treated with enterotomy and stone extraction (enterolithotomy) as the primary surgical approach, as it is associated with lower morbidity and mortality rates compared to more invasive procedures 1.
Diagnosis and Presentation
Gallstone ileus is a rare complication of gallstone disease, typically affecting elderly patients with a history of gallstone disease, and presents with symptoms of intestinal obstruction, including abdominal pain, nausea, vomiting, and abdominal distension. Diagnosis involves imaging studies such as abdominal X-rays, which may show air in the biliary tree (pneumobilia), signs of small bowel obstruction, and sometimes the ectopic gallstone (Rigler's triad). CT scans are more sensitive for detecting these findings 2.
Treatment Options
Treatment is primarily surgical, and the optimal approach is controversial. However, the most recent and highest quality study suggests that enterolithotomy alone is associated with better outcomes than more invasive techniques, such as one-stage procedures that include cholecystectomy and fistula repair 1. The one-stage procedure may be considered in stable patients, but it carries higher morbidity and mortality rates.
Morbidity and Mortality
The condition has a mortality rate of 6.67%, largely due to the advanced age and comorbidities of affected patients 1. Early recognition and prompt surgical intervention are essential to improve outcomes in gallstone ileus. The most common complications include acute renal failure, and the postoperative course may be complicated by dehiscence of the colic suture with acute peritonitis 3.
Key Considerations
- Enterolithotomy alone is the recommended primary surgical approach for gallstone ileus 1.
- One-stage procedures that include cholecystectomy and fistula repair may be considered in stable patients, but they carry higher morbidity and mortality rates.
- Early recognition and prompt surgical intervention are essential to improve outcomes in gallstone ileus.
- The condition has a significant mortality rate, largely due to the advanced age and comorbidities of affected patients.