Recurrent Gallstone Ileus Successfully Treated with Conservative Therapy

The Regularity of the Site of Impaction in Recurrent Gallstone Ileus: A Systematic Review and Meta-Analysis of Reported Cases

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.

A rare cause of duodenal obstruction: Bouveret syndrome

Gallstone ileus is a relatively rare pathology, most commonly obstructing the terminal ileum. Bouveret syndrome, leading to gastric outlet obstruction and seen with an incidence of less than 1%, is a syndrome met particularly in elderly patients and develops as the result of cholecysto-enteric fistula. In this report, it was aimed to present a 95-year-old case diagnosed with Bouveret syndrome.

Gallstone ileus with evident forchet sign:case report

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GSI is clinical entity of mechanical intestinal obstruction.

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It’s most commonly seen in elderly patients.

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CT scanning is the most sensitive and spesific radiological diagnostic method. Also riglers triad, forchet sign and petren sign are pathognomonic for CT scanning in GSI.

Introduction

Gallstone ileus (GSİ) is a rare complication of cholelithiasis (gallbladderstone), which may lead to obstruction of the small intestine. Particularly, computerized tomographic (CT) imaging method and special findings in these images help diagnosing of gallstone ileus. Treatment of this disease is surgery, surgery involves cholecystectomy + fistula repair + enterolitotomy, but it is controversial to perform cholecystectomy with enterolitotomy and fistula repair in the same session.

Presentation of case

A 75-year-old male patient consulted to the emergency department with the complaints of nausea and vomiting. In the examinations of the patient, bilienteric fistula and gallstones that impacted in the jejunum leading to obstruction were observed in abdominal CT images of the patient who has ileus. The patient was evaluated as gallstone ileus. In addition, on tomographic images significant Forchet sign and Rigler’s triad images were viewed which were pathognomonic for gallstone ileus and did not have images as clear as in our case in the literature search. Laparotomy was performed on the patient due to the fact that he was elderly and the duration of anesthesia was wanted to be kept short and stone was extracted by enterolitotomy. Cholecystectomy and fistula repair were left for another session because of gallbladder and surrounding tissues were edematous. The patient was discharged with full recovery on the 6th post-operative day.

Discussion–conclusion

As well as this disease is a rare cause of mechanical bowel obstruction, it is mostly seen in elderly patients. The most sensitive and specific imaging method in diagnosis is contrast-enhanced abdominal computerized tomography. In the tomographic images, especially the Rigler’s triad, Forchet sign and Petren sign are pathognomonic for gallstone ileus.

Gallstone ileus - the double challenge: case report and review of the literature

Gallstone ileus is a rare condition which occurs as an evolutive complication of biliary lithiasis. It occurs after stone migration from extrahepatic biliary tree to the digestive lumen, mostly through a biliary-enteric fistula. This condition involves repeated inflammatory relapses with the formation of local adhesions and generally requires a long evolution. The vast majority of patients with biliary ileus are third aged women who often have concomitant medical illnesses. Gallstone ileus surgery deals with the two components: bowel obstruction and biliary pole. Obstruction solving is approached as a surgical emergency and it requires an attitude adapted to the local situation. The attitude towards biliary surgery for gallstone ileus is a matter in debate. It could be one-stage surgery, elective surgery or expectancy and its choice is imposed by both local and general condition of the patient. We report the case of a middle-age woman whose first symptom of cholelithiasis was the gallstone ileus. Plain upright abdominal radiography revealed air-fluid levels with distended loops of the small bowel and pneumobilia. Laparotomy was decided and exploration revealed an impacted gallstone into the ileum and dense adhesions were found under the liver region. Enterolithotomy for gallstone removal was made. Postoperative evolution was uneventful with discharge on 7th day.