From the Research
Gallstone ileus should be treated with enterolithotomy alone, as it is associated with lower morbidity and mortality rates compared to more invasive procedures, such as one-stage surgery with cholecystectomy and fistula repair 1.
Diagnosis and Treatment
Gallstone ileus is a rare complication of gallstone disease where a large gallstone passes from the gallbladder into the intestine through a fistula and causes mechanical bowel obstruction. The standard approach involves an enterotomy (incision in the intestine) to extract the stone, followed by repair of the intestine.
- Preoperative management includes fluid resuscitation, correction of electrolyte imbalances, and administration of broad-spectrum antibiotics.
- Diagnosis is often made using abdominal CT scans, which may reveal Rigler's triad: pneumobilia (air in the biliary system), small bowel obstruction, and an ectopic gallstone.
- This condition occurs most commonly in elderly females with a history of gallstone disease and typically affects the terminal ileum.
Surgical Management
The optimal surgical approach for gallstone ileus is still debated, but the most recent and highest quality study suggests that enterolithotomy alone is the best option, as it is associated with lower morbidity and mortality rates compared to more invasive procedures 1.
- A one-stage procedure, which includes stone removal, cholecystectomy, and fistula repair, may be considered in stable patients, but it carries a higher risk of complications.
- The mortality rate for gallstone ileus remains significant, ranging from 5.5% to 6.67%, due to delayed diagnosis and the fact that affected patients are often elderly with multiple comorbidities 2, 1.
Recent Studies
Recent studies have compared the outcomes of different surgical procedures for gallstone ileus, including enterolithotomy alone, one-stage procedure, and bowel resection 1.
- These studies have consistently shown that enterolithotomy alone is associated with lower morbidity and mortality rates compared to more invasive procedures.
- The study by 1 found that enterolithotomy alone was associated with a lower mortality rate (5.3%) compared to one-stage procedure (7.1%) and bowel resection (7.4%).