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Pesce A, Lauro A, Gonella Pacchiotti C, D'Andrea V, Fabbri N, Bertasi M, Feo CV. Like a Rolling (Gall)Stone: Optimal Treatment of Gallstone Obstruction of the Sigmoid Colon. Dig Dis Sci 2024; 69:1593-1601. [PMID: 38466460 PMCID: PMC11098863 DOI: 10.1007/s10620-024-08328-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Sigmoid gallstone ileus is a rare complication of cholelithiasis, accounting for 1-4% of all cases of large-bowel obstruction. This is a highly morbid, and often fatal, condition due to its challenging diagnosis and late presentation. CASE PRESENTATION We report a case of a 90-year-old woman admitted to Emergency Department with abdominal pain and large-bowel obstruction due to a 6 cm gallstone lodged in a diverticulum of the proximal sigmoid colon as a consequence of a cholecysto-colonic fistula. Colonoscopy was deferred due to gallstone size carrying a high possibility of failure. The patient underwent urgent laparotomy with gallstone removal via colotomy. The cholecystocolonic fistula was left untreated. The post-operative course was uneventful; the patient was discharged on 6th post-operative day. CONCLUSION A multidisciplinary discussion between endoscopists and surgeons is often needed to choose the best therapeutic option, especially in high-risk patients.
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Affiliation(s)
- Antonio Pesce
- Unit of General Surgery, Department of Surgery, "Azienda Unità Sanitaria Locale" of Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, FE, Italy.
| | - Augusto Lauro
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Costanza Gonella Pacchiotti
- Unit of General Surgery, Department of Surgery, "Azienda Unità Sanitaria Locale" of Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, FE, Italy
| | - Vito D'Andrea
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Nicolò Fabbri
- Unit of General Surgery, Department of Surgery, "Azienda Unità Sanitaria Locale" of Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, FE, Italy
| | - Mario Bertasi
- Unit of General Surgery, Department of Surgery, "Azienda Unità Sanitaria Locale" of Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, FE, Italy
| | - Carlo Vittorio Feo
- Unit of General Surgery, Department of Surgery, "Azienda Unità Sanitaria Locale" of Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, FE, Italy
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2
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Knight AW, Wu R, Tennakoon L, Knowlton LM. Cholecystocolonic fistula: an unusual presentation of large bowel obstruction. Trauma Surg Acute Care Open 2024; 9:e001242. [PMID: 38196931 PMCID: PMC10773438 DOI: 10.1136/tsaco-2023-001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Affiliation(s)
- Ariel W Knight
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Ruoxue Wu
- Department of Surgery, Stanford University, Stanford, California, USA
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3
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Gavriilidis P, Paily A. Colonic Perforation Secondary to Gallstone Impaction in the Sigmoid Colon. Case Rep Surg 2023; 2023:9986665. [PMID: 37521369 PMCID: PMC10374380 DOI: 10.1155/2023/9986665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/28/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Gallstone sigmoid ileus is a very rare manifestation of large bowel obstruction. Mainly, three conditions predispose the manifestation of the entity; in particular, an episode of cholecystitis causing cholecysto-colonic fistula; a large gallstone; and narrowing of the sigmoid colon secondary to diverticular disease or malignancy. Case Report. An 82-year-old man presented to the emergency department with a one-week history of severe constipation, tachypnoea, tachycardia, hypotension, and high lactate. Physical examination demonstrated cyanosed upper and lower extremities and palpation of the abdomen revealed signs of peritonism, abdominal distention, and guarding. Computerized tomography scan demonstrated perforation of the hollow viscus organ secondary to impaction of the large gallstone in the sigmoid colon. Laparotomy revealed sigmoid perforation and widespread feculent peritonitis. The patient underwent Hartmann's procedure. After the intervention gave concerns regarding the patient's haemodynamic stability, he was transferred to the intensive care unit. The patient passed away on the third postoperative day due to complications secondary to haemodynamic instability. Conclusions Patients with early diagnosed uncomplicated sigmoid gallstone ileus can be managed with endoscopic mechanical lithotripsy. In case of failure, open or laparoscopic enterolithotomy can be applied. However, when patients present with complications, surgery should not be delayed. In our case, Hartmann's procedure was an absolute indication due to sigmoid perforation and widespread feculent peritonitis.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Surgery, Colchester General Hospital, Turner Road, Colchester CO4 5JL, UK
| | - Abhilash Paily
- Department of Surgery, Colchester General Hospital, Turner Road, Colchester CO4 5JL, UK
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4
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AlMuhsin AM, Bazuhair A, AlKhlaiwy O, Abu Hajar RO, Alotaibi T. Non-operative management of gallstone sigmoid ileus in a patient with a prostatic cancer. J Surg Case Rep 2023; 2023:rjad331. [PMID: 37305343 PMCID: PMC10256624 DOI: 10.1093/jscr/rjad331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023] Open
Abstract
Gallstone ileus is an uncommon complication of calculus cholecystitis through the formation of a biliary enteric fistula. The risk of mechanical obstruction caused by gallstones is increased with its size, in addition to chronic constipation, neoplasm and diverticulitis, to name a few. Here, we present a case of an 89-year-old male patient who presented with signs of bowel obstruction, which was found to be a gallstone impacted in the sigmoid colon. Considering the patient's stable condition and his comorbidities, a conservative approach was opted including IV fluids, fleet enema and bowel rest. Colonoscopy was performed and confirmed the passage of the stone. With no consensus regarding the management, the literature emphasizes a tailored approach to each case considering all possible operative and non-operative approaches. Some reports show promising results with non operative management. Gallstone ileus remains a challenging case, and further studies for the best treatment modalities are needed.
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Affiliation(s)
- Ahmed M AlMuhsin
- Corresponding author. Department of General Surgery, Security Forces Hospital, Dammam 31413, PO BOX 9003, Saudi Arabia. Tel: +966501589990; Fax: 0138103601; E-mail:
| | - Abdulaziz Bazuhair
- Department of General Surgery, Security Forces Hospital, Dammam 31413, Saudi Arabia
| | - Omar AlKhlaiwy
- Department of General Surgery, Security Forces Hospital, Dammam 31413, Saudi Arabia
| | - Rami O Abu Hajar
- Department of General Surgery, Security Forces Hospital, Dammam 31413, Saudi Arabia
| | - Thabit Alotaibi
- Adult Critical Care Department, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam 32314, Saudi Arabia
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5
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Augustin G, Bruketa T, Kunjko K, Romić I, Mikuš M, Vrbanić A, Tropea A. Colonic gallstone ileus: a systematic literature review with a diagnostic-therapeutic algorithm. Updates Surg 2023:10.1007/s13304-023-01537-0. [PMID: 37209317 DOI: 10.1007/s13304-023-01537-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/10/2023] [Indexed: 05/22/2023]
Abstract
Rare complication of gallstone disease is gallstone ileus. The common location is the small intestine, followed by the stomach. The rarest location is colonic gallstone ileus (CGI). To summarize and define the most appropriate diagnostic methods and therapeutic options for CGI based on the paucity of published data. Literature searches of English-, German-, Spanish-, Italian-, Japanese-, Dutch- and Portuguese language articles included and Italian-language articles using PubMed, EMBASE, Web of Science, The Cochrane Library, and Google Scholar. Additional studies were identified from the references of retrieved studies. 113 cases of CGI were recorded with a male to female patient ratio of 1:2.9. The average patient age was 77.7 years (range 45-95 years). The usual location of stone impaction was the sigmoid colon (85.8%), followed by a descending colon (6.6%), transverse colon (4.7%), rectum (1.9%), and lastly, ascending colon (0.9%). Gallstones ranged from 2 to 10 cm. The duration of symptoms was variable (1 day to 2 months), with commonly reported abdominal distension, obstipation, and vomiting; 85.2% of patients had previous biliary symptoms. Diverticular disease was present in 81.8% of patients. During the last 23 years, CT scan was the most common imaging method (91.5%), confirming the ectopic gallstone in 86.7% of cases, pneumobilia in 65.3%, and cholecytocolonic fistula in 68%. The treatment option included laparotomy with cololithotomy and primary closure (24.7%), laparotomy and cololithotomy with diverting stoma (14.2%), colonic resection with anastomosis (7.9%), colonic resection with a colostomy (12.4%), laparoscopy with cololithotomy with primary closure (2.6%), laparoscopy with cololithotomy with a colostomy (0.9%), colostomy without gallstone extraction (5.3%), endoscopic mechanical lithotripsy (success rate 41.1%), extracorporeal shock wave lithotripsy (1.8%). The cholecystectomy rate was 46.7%; during the initial procedure 25%, and as a separate procedure, 21.7%; 53.3% of patients had no cholecystectomy. The survival rate was 87%. CGI is the rarest presentation of gallstone ileus, mainly in women over 70 years of age, with gallstones over 2 cm, and predominantly in the sigmoid colon. Abdominal CT is diagnostic. Nonoperative treatment, particularly in subacute presentations, should be the first-line treatment. Laparotomy with cololithotomy or colonic resection is a standard procedure with favorable outcomes. There are no robust data on whether primary or delayed cholecystectomy is mandatory as a part of CGI management.
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Affiliation(s)
- Goran Augustin
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tomislav Bruketa
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Kristian Kunjko
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivan Romić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Gynecology and Obstetrics, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Adam Vrbanić
- Department of Gynecology and Obstetrics, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, University of Pittsburgh Medical Center, Palermo, Italy
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6
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Takagi T, Kinoshita S, Kawaguchi C, Kojima K, Ueno H, Nishimura N, Shimozato N, Shirai Y, Noguchi R, Ohyama T. Colonic gallstone ileus treated by a transanal ileus tube followed by spontaneous gallstone dislodgement: A case report. DEN OPEN 2023; 3:e145. [PMID: 35898849 PMCID: PMC9307740 DOI: 10.1002/deo2.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
A 71‐year‐old obese woman was referred to our hospital with lower left abdominal pain. Computed tomography showed a 46 mm elliptic calcification lodged in the sigmoid‐descending colon junction (SDJ), which had been detected 5 years prior but was not within the gall bladder at presentation. Therefore, we diagnosed colonic gallstone ileus with obstructive colitis caused by a gallstone. Colonoscopy revealed a smooth gallstone impacted at the sigmoid‐descending colon junction, which was not fixed and could be pushed proximally with the endoscope. Dislodgement of the stone was unsuccessful with both a large polypectomy snare and a retrieval basket. Considering the high risk of surgery, we chose a non‐surgical treatment strategy for obstructive colitis. Accordingly, a transanal ileus tube was placed to drain the proximal portion of the gallstone. The drainage of the colon by the ileus tube was satisfactory; the proximal colon was decompressed, ameliorating the obstructive colitis. Five days after tube placement, a colonoscopy revealed spontaneous passage of the gallstone into the rectum where it was finally removed. Cholecystocolonic fistula formation was confirmed by magnetic resonance imaging. We decided to surgically close the cholecystocolonic fistula to prevent future retrograde biliary infections. The surgery used a surgical stapler and was successful, with an uneventful postoperative course. Since radical surgical treatment of colonic gallstones and cholecystoenteric fistulas has a risk of postoperative morbidity and mortality, this case illustrates the importance of thoroughly considering nonsurgical interventions and surgeries for the safe treatment of colonic gallstone ileus.
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Affiliation(s)
| | | | | | | | - Hirotsugu Ueno
- Gut and Liver Center Heisei Memorial Hospital Nara Japan
| | | | | | - Yasuyo Shirai
- Gut and Liver Center Heisei Memorial Hospital Nara Japan
| | | | - Takao Ohyama
- Department of Surgery Heisei Memorial Hospital Nara Japan
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7
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Bertona S, Casas MA, Rotholtz NA. Laparoscopic Approach for the Treatment of Colonic Gallstone Ileus. J Gastrointest Surg 2023:10.1007/s11605-023-05629-5. [PMID: 36879059 DOI: 10.1007/s11605-023-05629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/04/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Sofía Bertona
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, C1118AAT, Buenos Aires, Argentina
| | - Maria A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, C1118AAT, Buenos Aires, Argentina.
| | - Nicolás A Rotholtz
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, C1118AAT, Buenos Aires, Argentina
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
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8
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Tonog P, Clar DT, Ebalo N, Appresai O. Single stage surgical management of a sigmoid gallstone ileus case. J Surg Case Rep 2023; 2023:rjad135. [PMID: 36926624 PMCID: PMC10014165 DOI: 10.1093/jscr/rjad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
Bowel obstruction/ileus is a relatively common occurrence in surgical practice with a predictable clinical presentation and management course. Rarely are these cases found consistent with gallstone etiology. Known as gallstone ileus (GI), this uncommon presentation is found primarily in elderly females (age > 65 years old) with multiple comorbid conditions; usually with coinciding presence of a cholecystoenteric fistula. Surgical management remains controversial due to the rarity of presentation and complexity of related pathological process. We present a case of a 69-year-old female who presented with typical signs/symptoms of bowel obstruction but found to have sigmoid GI on computed tomography imaging evaluation. A single stage exploratory laparotomy with simple enterolithotomy was performed with a positive outcome and uncomplicated postoperative recovery. The primary goal in reporting this case is to continue emphasizing the efficacy of a single stage simple enterolithotomy as the most ideal surgical management of this rare condition.
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Affiliation(s)
- Paul Tonog
- Department of Surgery, Cape Fear Valley Medical Center, Fayetteville, NC, USA
| | - Derek T Clar
- Department of Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, USA
| | - Nicole Ebalo
- Department of Surgery, Cape Fear Valley Medical Center, Fayetteville, NC, USA
| | - Ovie Appresai
- Department of Surgery, Cape Fear Valley Medical Center, Fayetteville, NC, USA
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9
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Liu YY, Bi SY, He QR, Fan Y, Wu SD. Developments in the Diagnosis and Management of Cholecystoenteric Fistula. J INVEST SURG 2022; 35:1841-1846. [PMID: 36167340 DOI: 10.1080/08941939.2022.2113188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis. CEF refers to one or more pathological perforations between the gallbladder and the adjacent gastrointestinal tract, first described by Bartholin in 1645. The aim of this review is to examine the etiology, symptoms, diagnosis, and treatment of CEF.Methods: A literature search was conducted according to a set of criteria in PubMed for historical and current peer-reviewed studies regarding CEF.Results: Clinical manifestations of CEF are always latent. Despite modern imaging studies and diagnostic methods, it is still very difficult to definitively diagnose CEF preoperatively. Instead, CEF is often accidentally discovered in the perioperative period or via intraoperative exploration.Conclusions: Without appropriate preoperative preparation, gastrointestinal injury and intraoperative bleeding often occur. CEF often goes unreported, and its diagnosis and treatment are still controversial. Early diagnosis of CEF is essential for effective treatment and improved outcome.
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Affiliation(s)
- Ying-Yu Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shi-Yuan Bi
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Quan-Run He
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ying Fan
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shuo-Dong Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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10
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Brunchmann A, Bjerrum F, Bulut M. Endoscopic electrohydraulic lithotripsy treatment of sigmoid bowel obstruction caused by gallstones. BMJ Case Rep 2022; 15:e249853. [PMID: 35473703 PMCID: PMC9045100 DOI: 10.1136/bcr-2022-249853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amanda Brunchmann
- Department of Surgery, Zealand University Hospital, Koge, Sjælland, Denmark
| | - Flemming Bjerrum
- Department of Surgery, Zealand University Hospital, Koge, Sjælland, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Mustafa Bulut
- Department of Surgery, Zealand University Hospital, Koge, Sjælland, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
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11
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Alzerwi NAN, Idrees B, Alsareii S, Aldebasi Y, Alsultan A. The Regularity of the Site of Impaction in Recurrent Gallstone Ileus: A Systematic Review and Meta-Analysis of Reported Cases. Can J Gastroenterol Hepatol 2021; 2021:5539789. [PMID: 34900851 PMCID: PMC8660221 DOI: 10.1155/2021/5539789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/18/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Due to the rarity of recurrent gallstone ileus (RGSI), its epidemiological and clinical features are elusive. With a focus on mortality and the site of impaction, this study consolidates the key clinical characteristics of index GSI (IGSI) and RGSI. Methods A meta-analysis of cases reported on RGSI was performed. Risk factors for mortality and site of impaction were examined, and a subgroup analysis was performed for age, sex, and site of impaction (jejunum, ileum, or others). Results In the final analysis, 50 (56 individual cases) studies were included. The paired data for the site of impaction was available for 45 patients. Women accounted for 87.3% of all RGSI cases included in the pooled analysis. The median age (interquartile range, IQR) of the patients was 70 (63-76) years, and the median time of recurrence (IQR) was 20.5 (8.5-95.5) days. The overall mortality rate was 11.8%, without correlation between the mortality rate and age, the time of recurrence, or the site of impaction. The region in which the stone was found in RGSI and IGSI was similar in most cases (p=0.002). Logistic regression also revealed a higher probability of stone impaction in the ileum in RGSI if it was the site of impaction in IGSI. In most cases, enterolithotomy was the preferred method. Conclusions A high index of suspicion for RGSI should be maintained for older women with a history of GSI. The region where the stone was impacted during IGSI should be investigated first in such patients.
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Affiliation(s)
- Nasser A. N. Alzerwi
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, Al-Majmaah City, 11952, P.O. Box 66, Riyadh, Saudi Arabia
| | - Bandar Idrees
- Gastrointestinal, Biliopancreatic, and Minimally Invasive Surgery at Department of Surgery, Prince Sultan Military Medical City in Riyadh, Makkah Al Mukarramah Rd, As Sulimaniyah, Riyadh 12233, Saudi Arabia
| | - Saeed Alsareii
- Department of Surgery, College of Medicine, Najran University, Najran, Saudi Arabia
| | - Yaser Aldebasi
- Board Certified General Surgeon, Department of Surgery, King Salman Hospital in Riyadh, Riyadh, Saudi Arabia
| | - Afnan Alsultan
- Resident in Training, Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia
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12
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Roberson JL, Krumeich LN, Darwich NF, Babatunde V, Laczko D, Albee A, Yang Z, Jack AE, Shlansky-Goldberg R, DeAgostino-Kelly M, Braslow BM. Fibroid expulsion: a unique presentation of mechanical small bowel obstruction 11 years after uterine artery embolization: a case report. J Med Case Rep 2021; 15:356. [PMID: 34238340 PMCID: PMC8268189 DOI: 10.1186/s13256-021-02917-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 11/11/2022] Open
Abstract
Background Uterine artery embolization in the treatment of uterine leiomyoma has been rarely associated with dislodgement and expulsion of infarcted uterine fibroids through the vagina, peritoneum, or bowel wall, predominantly occurring within 6 months of uterine artery embolization. Case presentation We present the case of a 54-year-old African American woman who underwent uterine artery embolization 11 years prior and developed mechanical small bowel obstruction from the migration of fibroid through a uteroenteric fistula with ultimate impaction within the distal small bowel lumen. Small bowel resection and hysterectomy were curative. Conclusions Uteroenteric fistula with small bowel obstruction due to fibroid expulsion may present as a delayed finding after uterine artery embolization and requires heightened awareness.
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Affiliation(s)
- Jeffrey L Roberson
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA, 19104, USA.
| | - Lauren N Krumeich
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA, 19104, USA
| | - Nabil F Darwich
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Victor Babatunde
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Dorottya Laczko
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Andrew Albee
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Zhaohai Yang
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Amr El Jack
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | | | - Mary DeAgostino-Kelly
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Benjamin M Braslow
- Division of Trauma, Surgical Critical Care, and Emergency Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
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13
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Crosen M, Ghattas P, Sandhu R. Large bowel obstruction secondary to gallstones. J Surg Case Rep 2021; 2021:rjab137. [PMID: 34025967 PMCID: PMC8130875 DOI: 10.1093/jscr/rjab137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/16/2021] [Indexed: 11/15/2022] Open
Abstract
Gallstone ileus is a rare complication of cholelithiasis, representing 1% of bowel obstructions. The usual site of obstruction is the ileocecal valve, though other sites have been reported. Here, we present two cases of gallstone ileus within the distal colon requiring surgical intervention. Two elderly females presented with vague abdominal symptoms secondary to large bowel obstruction from gallstone impaction. Both underwent attempted endoscopic retrieval without success. Patient 1 required laparoscopy converted to exploratory laparotomy with colotomy and removal of the stone. Patient 2 required partial colectomy and end colostomy formation due to acute sigmoid inflammation. Gallstone ileus is a rare cause of intestinal obstruction, though incidence increases with age. Cholecystocolonic fistulas allow stones to bypass the ileocecal valve, with the potential for impaction in the colon at the site of a stricture or tortuosity. Surgical intervention may be required in cases not amenable to successful endoscopic retrieval.
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Affiliation(s)
- Matelin Crosen
- Department of Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Paul Ghattas
- Department of Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Rovinder Sandhu
- Department of Surgery, Lehigh Valley Health Network, Allentown, PA, USA
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14
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Gupta AK, Edwards B, Vega JA. The Tumbling Bullet: Subacute Intestinal Obstruction due to a Retained Bullet. Cureus 2020; 12:e9844. [PMID: 32953351 PMCID: PMC7497767 DOI: 10.7759/cureus.9844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022] Open
Abstract
A 29-year-old female presented with multiple gunshot wounds to the back and bilateral lower extremities. The patient underwent an exploratory laparotomy with small-bowel resection of two segments with primary stapled anastomosis and partial nephrectomy. The postoperative course showed prolonged intermittent bowel obstruction secondary to the bullet, which lodged in the distal ileum. The patient eventually passed the bullet; it, however, led to a delay in recovery.
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Affiliation(s)
- Anupam K Gupta
- Minimally Invasive Surgery, University of Miami Hospital, Miami, USA
| | - Blake Edwards
- General Surgery, Boca Raton Regional Hospital, Florida Atlantic University, Boca Raton, USA
| | - Jorge A Vega
- Trauma and Acute Care Surgery, St. Mary's Medical Center, Florida Atlantic University, West Palm Beach, USA
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Michael N, Ranney D, Vekstein A, Montgomery S. Cholecystocolonic Fistula in the Setting of Sigmoid Perforation from Gallstone. Am Surg 2020. [DOI: 10.1177/000313481908501214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nicholas Michael
- Uniformed Services University of the Health Sciences Bethesda, Maryland
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Abstract
Background Gallstone ileus is an important complication of cholecystolithiasis. In general, surgery is the treatment of choice for such cases, but clinicians face difficulty in the selection of an appropriate approach. Closure of a cholecystoenteric fistula can be achieved through one-stage or two-stage operation. Two-stage operation has a lower mortality rate than a one-stage procedure, but persistence of the cholecystoenteric fistula is associated with the risk of carcinogenesis and recurrence of gallstone ileus. Objective This study reviews the different surgical approaches according to the impaction site of the gallstone, using data of previous studies by our group and clinical reports in the literature. Conclusions First, for cases involving impaction at the duodenum, the cholecystoenteric fistula can be repaired in the same surgical field, and one-stage operation obtains favourable outcome; hence, one-stage operation is considered as treatment of choice. Second, for cases involving impaction at the small intestine, natural closure of the cholecystoenteric fistula or low mortality is expected; hence, two-stage operation may be performed, possibly using minimally invasive laparoscopy. Third, for cases involving impaction at the colon, natural closure of the cholecystocolonic fistula is unlikely, and patients have a high risk of reflux cholangitis due to faecal fluid; hence, one-stage operation is considered as treatment of choice.
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Affiliation(s)
- Koichi Inukai
- Department of Acute Care Surgery, Sakai City Medical Center, Sakai, Osaka, Japan
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Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Curr Probl Surg 2018; 56:49-90. [PMID: 30777150 DOI: 10.1067/j.cpsurg.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nicholas G Farkas
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Ted Joseph P Welman
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Talisa Ross
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Brown
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jason J Smith
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nikhil Pawa
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Hajjar R, Létourneau A, Henri M, Heyen F, Latulippe JF, Poirier M, Tremblay JF, Trépanier JS, Bendavid Y. Cholecystocolonic fistula with a giant colonic gallstone: the mainstay of treatment in an acute setting. J Surg Case Rep 2018; 2018:rjy278. [PMID: 30349664 PMCID: PMC6189374 DOI: 10.1093/jscr/rjy278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 09/20/2018] [Accepted: 10/03/2018] [Indexed: 11/23/2022] Open
Abstract
A cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis with cholecystitis. Cholecystocolonic fistulas (CCFs) account for 8–26.5% of all CEFs. CCFs can cause colonic bleeding, obstruction or perforation, with such complications being mainly reported in the narrower sigmoid colon. Colonic biliary ileus, or obstruction due to the colonic gallstone impaction, is extremely rare in the proximal colon and its best management is yet to be elucidated. We present the case of a 73-year-old male patient with multiple comorbidities and previous abdominal surgeries who presented with hematochezia and intestinal obstructive symptoms. Imaging revealed a giant 5 × 7 cm2 gallstone in the proximal transverse colon. Laparotomy and stone extraction via colotomy were performed. Complicated proximal colonic gallstones are exceedingly rare with several operative and non-operative treatments already described. A time-saving surgery in a patient with serious comorbidities is reasonable when compared to a more extensive procedure including enterolithotomy, cholecystecomy and fistula closure.
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Affiliation(s)
- Roy Hajjar
- Université de Montréal, Programme de Chirurgie Générale, Hôpital Maisonneuve-Rosemont, 5415 Boul de l'Assomption, Montréal QC
| | - Audrey Létourneau
- Université de Montréal, Programme de Chirurgie Générale, Hôpital Maisonneuve-Rosemont, 5415 Boul de l'Assomption, Montréal QC
| | - Margaret Henri
- Hôpital Maisonneuve-Rosemont, Service de Chirurgie Colorectale, 5415 Boul de l'Assomption, Montréal, Quebec, Canada
| | - Françoise Heyen
- Hôpital Maisonneuve-Rosemont, Service de Chirurgie Colorectale, 5415 Boul de l'Assomption, Montréal, Quebec, Canada
| | - Jean-François Latulippe
- Hôpital Maisonneuve-Rosemont, Service de Chirurgie Colorectale, 5415 Boul de l'Assomption, Montréal, Quebec, Canada
| | - Madeleine Poirier
- Hôpital Maisonneuve-Rosemont, Service de Chirurgie Colorectale, 5415 Boul de l'Assomption, Montréal, Quebec, Canada
| | - Jean-François Tremblay
- Hôpital Maisonneuve-Rosemont, Service de Chirurgie Colorectale, 5415 Boul de l'Assomption, Montréal, Quebec, Canada
| | - Jean-Sébastien Trépanier
- Hôpital Maisonneuve-Rosemont, Service de Chirurgie Colorectale, 5415 Boul de l'Assomption, Montréal, Quebec, Canada
| | - Yves Bendavid
- Hôpital Maisonneuve-Rosemont, Service de Chirurgie Colorectale, 5415 Boul de l'Assomption, Montréal, Quebec, Canada
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