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Gallstone ileus: monocentric experience looking for the adequate approach

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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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Abbreviations

BS:

Bouveret syndrome

CT:

Computerized tomography

ERCP:

Endoscopic retrograde cholangio pancreatography

GI:

Gallstone ileus

IDDM:

Insulin-dependent diabetes mellitus

MRI:

Magnetic resonance imaging

NIDDM:

Non-insulin-dependent diabetes mellitus

References

  1. Ayantunde AA, Agrawal A (2007) Gallstone ileus: diagnosis and management. World J Surg 31:1292–1297

    CAS  PubMed  Google Scholar 

  2. Reisner RM, Cohen JR (1994) Gallstone ileus: a review of 1001 reported cases. Am Surg 60(6):441–446

    CAS  PubMed  Google Scholar 

  3. Kurtz RJ, Heimann TM, Beck AR, Kurtz AB (1985) Pattern of treatment of gallstone ileus over a 45-year period. Am J Gastroenterol 80:95-8

    CAS  PubMed  Google Scholar 

  4. Andersson H, Bosaeus I, Fasth S, Hellberg R, Hultén L (1987) Cholelithiasis and urolithiasis in Crohn’s disease. Scand J Gastroenterol 22:253–256

    Article  CAS  Google Scholar 

  5. Almogy G, Bauer JJ, Venturero M, Presen DH (2000) Gallstone ileus and Crohn’s disease without biliary-enteric fistula: report of a unique case. Mt Sinai J Med 67(2):159–162

    CAS  PubMed  Google Scholar 

  6. Pezzoli A, Maimone A, Fusetti N, Pizzo E (2015) Gallstone ileus treated with non-surgical conservative methods: a case report. J Med Case Rep 9:15

    Article  Google Scholar 

  7. Montgomery A (1993) Laparoscope-guided enterolithotomy for gallstone ileus. Surg Laparosc Endosc 3:310–314

    CAS  PubMed  Google Scholar 

  8. Franklin ME Jr, Dorman JP, Schuessler WW (1994) Laparoscopic treatment of gallstone ileus: a case report and review of the literature. J Laparoendosc Surg 4(4):265–272

    Article  Google Scholar 

  9. Dindo D, Demartines N, Clavien PA (2004) Classification of Surgical Complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  10. Clavien PA, Richon J, Burgan S, Rohner A (1990) Gallstone ileus. Br J Surg 77:737–742

    Article  CAS  Google Scholar 

  11. Vick RM (1932) Statistics of acute intestinal obstruction. Br Med J 2:546–548

    Article  CAS  Google Scholar 

  12. Buetow GW, Crampton RS (1963) Gallstone ileus: a report of 23 cases. Arch Surg 86:504–511

    Article  CAS  Google Scholar 

  13. Kirchmayr W, Muhlmann G, Zitt M, Bodner J, Weiss H, Klaus A (2005) Gallstone ileus: rare and still controversial. ANZ J Surg 75:234–238

    Article  Google Scholar 

  14. Fox PF (1970) Planning the operation for cholecystoenteric fistula with gallstone ileus. Surg Clin North Am 50:93–102

    Article  CAS  Google Scholar 

  15. Beltran MA, Csendes A, Cruces KS (2008) The relationship of Mirizzi syndrome and cholecystoenteric fistula: validation of a modified classification. World J Surg 32:2237–2243

    Article  Google Scholar 

  16. Masannat Y, Masannat Y, Shatnawei A (2006) Gallstone ileus: a review. Mt Sinai J Med 73:1132–1134

    PubMed  Google Scholar 

  17. Abou-Saif A, Al-Kawas FH (2002) Complications of gallstone disease: mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Am J Gastroenterol 97:249–254

    Article  Google Scholar 

  18. Zaliekas J, Munson JL (2008) Complications of gallstones: the Mirizzi syndrome, gallstone ileus, gallstone pancreatitis, complications of “lost” gallstones. Surg Clin North Am 88:1345–1368

    Article  Google Scholar 

  19. Zehetner J, Shamiyeh A, Wayand W (2007) Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg 193:73–78

    Article  Google Scholar 

  20. Zingales F, Pizzolato E, Menegazzo M, Da Re C, Bardini R (2011) Gallstone ileus of the sigmoid colon: a rare complication of cholelithiasis. Updates Surg 63(3):219–221

    Article  Google Scholar 

  21. Cappell MS, Davis M (2006) Characterization of Bouveret’s syndrome: a comprehensive review of 128 cases. Am J Gastroenterol 101(9):2139–2146

    Article  Google Scholar 

  22. Iniguez A, Butte JM, Zuniga JM, Crovari F, Llanos O (2008) Bouveret syndrome: report of four cases. Rev Med Chil 136(2):163–168

    Article  Google Scholar 

  23. Sica GS, Sileri P, Gaspari AL (2005) Laparoscopic treatment of Bouveret’s syndrome presenting as acute pancreatitis. JSLS 9:472–475

    PubMed  PubMed Central  Google Scholar 

  24. Halabi WJ, Kang CY, Ketana N, LafaroKJ Nguyen VQ, Stamos MJ, Imagawa DK, Demirjian AN (2014) Surgery for gallstone ileus: a nationwide comparison of trends and outcomes. Ann Surg 259:329–335

    Article  Google Scholar 

  25. Yoo P, Mulkeen A, Frattini J, Longo W, Cha CH (2006) Assessing risk factors for adverse outcomes in emergent colorectal surgery. Surg Oncol 15:85–89

    Article  Google Scholar 

  26. Margenthaler JA, Longo WE, Virgo KS, Johnson FE, Grossmann EM, Schifftner TL, Henderson WG, Khuri SF (2006) Risk factors for adverse outcomes following surgery for small bowel obstruction. Ann Surg 243:456–464

    Article  Google Scholar 

  27. Rigler LG, Borman CN, Noble JF (1941) Gallstone obstruction: pathogenesis and roentgen manifestations. JAMA 117:1753–1759

    Article  Google Scholar 

  28. Balthazar EJ, Schechter LS (1978) Air in gallbladder: a frequent finding in gallstone ileus. Am J Roentgenol 131:219–222

    Article  CAS  Google Scholar 

  29. Lassandro F, Gagliardi N, Scuderi M, Pinto A, Gatta G, Mazzeo R (2004) Gallstone ileus analysis of radiological findings in 27 patients. Eur J Radiol 50:23–29

    Article  Google Scholar 

  30. Yu CY, Lin CC, Shyu RY, Hsieh CB, Wu HS, Tyan YS, Hwang JI, Liou CH, Chang WC, Chen CY (2005) Value of CT in the diagnosis and management of gallstone ileus. World J Gastroenterol 11(14):2142–2147

    Article  Google Scholar 

  31. Pickhardt PJ, Bhalla S, Balfe DM (2002) Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Radiology 224:9–23

    Article  Google Scholar 

  32. Hung YM, Lin SL, Hung SY, Huang WC, Wang PY (2012) Preventing radiocontrast induced nephropathy in chronic kidney disease patients undergoing coronary angiography. World J Cardiol 4(5):157–172

    Article  Google Scholar 

  33. Rodriguez-Sanjuan JC, Casado F, Fernandez MJ, Morales DJ, Naranjo A (1997) Cholecystectomy and fistula closure versus enterolithotomy alone in gallstone ileus. Br J Surg 84:634–637

    Article  CAS  Google Scholar 

  34. Doko M, Zovak M, Kopljar M, Glavan E, Ljubicic N, Hochstädter H (2003) Comparison of surgical treatments of gallstone ileus: preliminary report. World J Surg 27(4):400–404

    Article  Google Scholar 

  35. Deckoff SL (1955) Gallstone ileus: a report of 12 cases. Ann Surg 142:52–65

    Article  CAS  Google Scholar 

  36. Warshaw AL, Bartlett MK (1966) Choice of operation for gallstone intestinal obstruction. Ann Surg 164:1051–1055

    Article  CAS  Google Scholar 

  37. Ravikumar R, Williams JG (2010) The operative management of gallstone ileus. Ann Roy Coll of Surg 92:279–281

    Article  Google Scholar 

  38. Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL (2016) Gallstone ileus, clinical presentation, diagnostic and treatment approach. World J Gastrointest Surg 8:65–76

    Article  Google Scholar 

  39. Lubbers H, Mahlke R, Lankisch PG (1999) Gallstone ileus: endoscopic removal of a gallstone obstructing the upper jejunum. J Inter Med 246:593–597

    Article  CAS  Google Scholar 

  40. Katsinelos P, Dimiropoulos S, Tsolkas P, Baltagiannis S, Kapelidis P, Galanis I, Papaziogas B, Georgiadou E, Vasiliadis I (2002) Successful treatment of duodenal bulb obstruction caused by a gallstone (Bouveret’s syndrome) after endoscopic mechanical lithotripsy. Surg Endosc 16:1363

    Article  CAS  Google Scholar 

  41. Muratori R, Cennamo V, Menna P, Cecinato P, Eusebi LH, Mazzella G, Bazzoli F (2012) Colonic gallstone ileus treated with radiologically guided extracorporeal shock wave lithotripsy followed by endoscopic extraction. Endoscopy 44:E88–E89

    Article  Google Scholar 

  42. Meyenberger C, Michel C, Metzger U, Koelz HR (1996) Gallstone ileus treated by extracorporeal shockwave lithotripsy. Gastrointest Endosc 43:508–511

    Article  CAS  Google Scholar 

  43. Webb LH, Ott MM, Gunter OL (2010) Once bitten, twice incised: recurrent gallstone ileus. Am J Surg 200:72–74

    Article  Google Scholar 

  44. Conzo G, Mauriello C, Gambardella C, Napolitano S, Cavallo F, Tartaglia E, Santini L (2013) Gallstone ileus: one-stage surgery in an elderly patient: one-stage surgery in gallstone ileus. Int J Surg Case Rep 4(3):316–318

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. General Surgery Department, “San Lazzaro” Hospital, Via P. Belli 26, 12051, Alba, CN, Italy

    Vincenzo Scuderi, Vincenzo Adamo, Marco Naddeo, William Di Natale, Ljevin Boglione & Sebastiano Cavalli

Authors
  1. Vincenzo Scuderi
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  2. Vincenzo Adamo
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  3. Marco Naddeo
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  4. William Di Natale
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  5. Ljevin Boglione
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  6. Sebastiano Cavalli
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Contributions

Study conception and design, acquisition, analysis, and interpretation of data, drafting of the manuscript: VS. Critical revision: SC, VA, MN, LB, WDN.

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Correspondence to Vincenzo Scuderi.

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Scuderi, V., Adamo, V., Naddeo, M. et al. Gallstone ileus: monocentric experience looking for the adequate approach. Updates Surg 70, 503–511 (2018). https://doi.org/10.1007/s13304-017-0495-z

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  • DOI: https://doi.org/10.1007/s13304-017-0495-z

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