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Gupta V, Abhinav A, Vuthaluru S, Kalra S, Bhalla A, Rao AK, Goyal MK, Vuthaluru AR. The Multifaceted Impact of Gallstones: Understanding Complications and Management Strategies. Cureus 2024; 16:e62500. [PMID: 39022477 PMCID: PMC11252534 DOI: 10.7759/cureus.62500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
Gallstones, or cholelithiasis, represent a prevalent gastrointestinal disorder characterized by the formation of calculi within the gallbladder. This review aims to provide a comprehensive analysis of the complications associated with gallstones, with a focus on their pathophysiology, clinical manifestations, diagnostic methodologies, and management strategies. Gallstone-related complications encompass a broad spectrum, including biliary colic, acute cholecystitis, choledocholithiasis, acute pancreatitis, and cholangitis. The pathogenesis of these complications primarily involves biliary obstruction and subsequent infection, leading to significant morbidity and potential mortality. Diagnostic evaluation of gallstone complications employs various imaging techniques, such as ultrasonography, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP), each with distinct advantages and limitations. Therapeutic approaches are discussed, ranging from conservative management with pharmacotherapy and bile acid dissolution agents to interventional procedures like extracorporeal shock wave lithotripsy (ESWL) and percutaneous cholecystostomy. Surgical management, particularly laparoscopic cholecystectomy, remains the gold standard for definitive treatment. Additionally, advancements in endoscopic techniques, including endoscopic sphincterotomy (EST) and cholangioscopy, are highlighted. This review synthesizes current research findings and clinical guidelines, aiming to enhance the understanding and management of gallstone-related complications among healthcare professionals, thereby improving patient outcomes and reducing the burden of this common ailment.
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Affiliation(s)
- Varsha Gupta
- Anesthesiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, IND
| | - Abhinav Abhinav
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
| | | | - Shivam Kalra
- Internal Medicine, Trident Medical Center, North Charleston, USA
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Akshita Bhalla
- Internal Medicine, Punjab Institute of Medical Sciences, Jalandhar, IND
| | - Abhinav K Rao
- Internal Medicine, Trident Medical Center, North Charleston, USA
| | - Manjeet K Goyal
- Gastroenterology and Hepatology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ashita R Vuthaluru
- Anesthesia and Critical Care, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, IND
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Kularatna M, Falconer F. Double Trouble: A Case of Gallstone Ileus as a Result of Multiple Obstructive Gallstones. Case Rep Surg 2023; 2023:7423380. [PMID: 37927905 PMCID: PMC10624547 DOI: 10.1155/2023/7423380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/27/2023] [Accepted: 09/01/2023] [Indexed: 11/07/2023] Open
Abstract
Gallstone ileus is a rare condition. It accounts for approximately 1% of small bowel obstruction and is more prevalent in the elderly population. It is usually present in relatively comorbid patients posing further operative challenges. The following report investigates the management of two large gallstones resulting in two different points of obstruction. Is double trouble doubly hard to manage?
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Affiliation(s)
- Malsha Kularatna
- General Surgical Registrar Bay of Plenty District Health Board, 90 Pakanga Grove, Pyes Pa, Otago, New Zealand
| | - Fransiska Falconer
- General Surgical Registrar Tauranga Hospital, 66 Te Horo Drive, Ohope, New Zealand
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García-Quijada García J, Valle Rubio A, Pastor Riquelme P, Serantes Gómez A. Case report: Closed-loop bowel obstruction secondary to a double gallstone ileus. Int J Surg Case Rep 2021; 89:106612. [PMID: 34823163 PMCID: PMC8627953 DOI: 10.1016/j.ijscr.2021.106612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/30/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance In this paper, we report an unusual case of a closed-loop bowel obstruction secondary to a double gallstone ileus. This type of pathology constitutes an emergency, and requires prompt surgical intervention to prevent further complications. Presentation of case The patient was a 90-year-old female who came to our emergency room with a clinical picture compatible with an acute abdomen. Imaging tests performed included a plain radiograph and abdominal CT-scan, which confirmed the diagnosis. The patient was then transferred to the operating room, and an open double enterolithotomy was performed, extracting two cylindrical gallstones with a diameter of over 2.5 cm. No treatment was given for either the gallbladder nor the biliary-enteric fistula due to the patient's physical status. Clinical discussion Gallstone ileus is a rare entity, but must be taken into consideration when a patient with an abdominal obstruction arrives to the emergency department, especially when signs such as pneumobilia or visualization of the stones are detected by imaging tests. Early surgical intervention is required to avoid complications. However, addressing the biliary-enteric fistula at the same time is a sensitive procedure that may not be advisable, depending on the status of the patient. This report includes a bibliographic review of existing cases of gallstone ileus and the specifics of its diagnosis and management. Conclusion This pathology can lead to serious complications if not managed properly. Prompt diagnosis and surgical intervention are essential to avoid complications such as intestinal gangrene and perforation. Inspecting the entire intestine during surgery is crucial for removing any additional gallstones that may be present to prevent the reappearance of symptoms. Gallstone ileus is an uncommon condition which requires an emergency surgical approach. The entire intestine should be inspected during surgery. A prompt diagnosis can be achieved via CT-scan. Management of gallbladder and biliary-enteric fistula is controversial. Enterolithotomy is the procedure of choice for relieving intestinal obstruction.
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Affiliation(s)
| | - Ainhoa Valle Rubio
- Hospital Universitario de Getafe, Madrid, Carretera Madrid-Toledo km 12.5, 28905, Spain
| | - Pablo Pastor Riquelme
- Hospital Universitario de Getafe, Madrid, Carretera Madrid-Toledo km 12.5, 28905, Spain
| | - Ana Serantes Gómez
- Hospital Universitario de Getafe, Madrid, Carretera Madrid-Toledo km 12.5, 28905, Spain
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Kumar N, Anjum R, Mani R, Karki B. Neglected Gallstone Disease Presented As Gallstone Ileus: A Rare Cause of Intestinal Obstruction. Cureus 2021; 13:e18205. [PMID: 34722021 PMCID: PMC8544619 DOI: 10.7759/cureus.18205] [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] [Accepted: 09/22/2021] [Indexed: 11/21/2022] Open
Abstract
Gallstone ileus is a rare complication of cholelithiasis seen in patients with a long history of cholelithiasis. It occurs more in the older age group and in the female gender. These patients have poor general condition and therefore selection of appropriate treatment is difficult. The clinician has to make a decision between immediate one-stage or two-stage closure of the cholecysto-intestinal fistula or waiting for natural closure. We have discussed the management of a rare cause of small bowel obstruction due to complication of untreated cholelithiasis.
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Affiliation(s)
- Navin Kumar
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Rohik Anjum
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Rishit Mani
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Bibek Karki
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
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Urru A, Romano N, Borda F, Melani EF, Rollandi GA. Intestinal "stones bag" in Crohn's disease. Intern Emerg Med 2021; 16:1711-1713. [PMID: 33389451 DOI: 10.1007/s11739-020-02588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Alessia Urru
- Department of Health Sciences (DISSAL) - Radiology Section, University of Genoa, 16132, Genoa, Italy.
| | - Nicola Romano
- Department of Neuroradiology, E.O. Ospedali Galliera, 16128, Genoa, Italy
| | - Fabio Borda
- Department of Health Sciences (DISSAL) - Radiology Section, University of Genoa, 16132, Genoa, Italy
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Bouveret Syndrome: A Systematic Review of Endoscopic Therapy and a Novel Predictive Tool to Aid in Management. J Clin Gastroenterol 2020; 54:758-768. [PMID: 32898384 DOI: 10.1097/mcg.0000000000001221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND GOALS Bouveret syndrome is characterized by gastroduodenal obstruction caused by an impacted gallstone. Current literature recommends endoscopic therapy as the first line of intervention despite significantly lower success rates compared with surgery. The lack of treatment efficacy studies and the paucity of clinical guidelines contribute to current practices being arbitrary. The aim of this systematic review was to identify factors that predict outcomes of endoscopic therapy. Subsequently, a predictive tool was devised to predict the success of endoscopic therapy and recommendations were proposed to improve current management strategies of impacted gallstones in the upper gastrointestinal tract. METHODS A systematic search of PubMed, Medline, Cochrane, and Scopus was performed for articles that contained the terms "Bouveret syndrome," "Bouveret's syndrome," "gallstone" AND "gastric obstruction" and "gallstone" AND "duodenal obstruction" that were published between January 1, 1950 to April 15, 2018. Articles were reviewed by 3 reviewers and raw data collated. χ and Kolmogorov-Smirnov tests were used to test associations between predictors and endoscopic outcomes. A logistic regression model was then used to create a predictive tool which was cross validated. RESULTS Failure of endoscopic therapy is associated with increasing gallstone length (P<0.0001) and impaction in the distal duodenum (P<0.05). Using multiple endoscopic modalities is associated with better success rates (P<0.05). The novel predictive tool predicted success of endoscopic therapy with an area under the receiver operating characteristic score of 0.86 (95% confidence interval: 0.79-0.94). CONCLUSION In Bouveret syndrome, a selective approach to endoscopic therapy can expedite definitive treatment and improve current management strategies.
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Sertkaya M, Emre A, Akbulut S, Vicdan H, Şanlı AN. A typical gallstone ileus: Clinical, radiological and operational findings. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2019; 30:377-380. [PMID: 30457562 PMCID: PMC6453646 DOI: 10.5152/tjg.2018.18347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Mehmet Sertkaya
- Department of General Surgery, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Arif Emre
- Department of General Surgery, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Sami Akbulut
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Halit Vicdan
- Department of Radiology, Kilis State Hospital, Kilis, Turkey
| | - Ahmet Necati Şanlı
- Department of General Surgery, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
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Gandhi S, Jani N. Rare cause of gastric outlet obstruction. J Community Hosp Intern Med Perspect 2018; 8:84-86. [PMID: 29686795 PMCID: PMC5906763 DOI: 10.1080/20009666.2018.1452517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/08/2018] [Indexed: 02/08/2023] Open
Abstract
Bouveret’s syndrome is a rare cause of gastric outlet obstruction. The stones enter the small bowel via cholecysto-enteric fistula. The most common presenting symptoms are abdominal pain, nausea and vomiting. The gold standard diagnostic test isesophagogastroduodenoscopy (EGD). Rigler’s triad on abdominal x-ray is classic. CT scan findings are pneumobilia, cholecystoduodenal fistula and a gallstone in the duodenum. We present a case of a 75-year-old female who presents with 3 week history of nausea, vomiting, and diffuse abdominal pain. Initial presentation, imaging and EGD was concerning for malignancy. She was later diagnosed to have Bouveret’s syndrome and underwent laparoscopic small bowel enterotomy with removal of gallstones
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Affiliation(s)
- Sonal Gandhi
- Department of Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Niraj Jani
- Department of Gastroenterology, Greater Baltimore Medical Center, Baltimore, MD, USA
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AL-Habbal Y, Ng M, Bird D, McQuillan T, AL-Khaffaf H. Uncommon presentation of a common disease - Bouveret's syndrome: A case report and systematic literature review. World J Gastrointest Surg 2017; 9:25-36. [PMID: 28138366 PMCID: PMC5237820 DOI: 10.4240/wjgs.v9.i1.25] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/30/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate and summarise the current evidence surrounding management of Bouveret's syndrome (BS). METHODS A MEDLINE search was performed for the BS. The search was conducted independently by two clinicians (Yahya AL-Habbal and Matthew Ng) in April 2016. A case of BS is also described. RESULTS A total of 315 articles, published from 1967 to 2016, were found. For a clinically meaningful clinical review, articles published before 01/01/1990 and were excluded, leaving 235 unique articles to review. Twenty-seven articles were not available (neither by direct communication nor through inter-library transfer). These were also excluded. The final number of articles reviewed was 208. There were 161 case reports, 13 reviews, 23 images (radiological and clinical images), and 11 letters to editor. Female to male ratio was 1.82. Mean age was 74 years. Treatment modalities included laparotomy in the majority of cases, laparoscopic surgery, endoscopic surgery and shockwave lithotripsy. CONCLUSION There is limited evidence in the literature about the appropriate approach. We suggest an algorithm for management of BS.
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Sahsamanis G, Maltezos K, Dimas P, Tassos A, Mouchasiris C. Bowel obstruction and perforation due to a large gallstone. A case report. Int J Surg Case Rep 2016; 26:193-6. [PMID: 27497941 PMCID: PMC4975710 DOI: 10.1016/j.ijscr.2016.07.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/08/2016] [Accepted: 07/28/2016] [Indexed: 12/13/2022] Open
Abstract
Gallstone obstruction is a rare clinical entity presenting usually in elderly patients and is associated with a medical history of biliary symptoms. CT examination uncovered all findings consisting Rigler’s triad, thus air in the gall bladder, bowel obstruction and a gallstone inside the bowel lumen. It also identified a cholecystoduodenal fistula. Rupture of the small bowel occurred intraoperatively, and a large 3.2 cm gallstone was located in the terminal ileum, which was recovered. Post-surgical recovery was uneventful with no further report of obstruction symptoms at 6 month follow up.
Introduction Gallstone bowel obstruction is a rare form of mechanical ileus usually presenting in elderly patients, and is associated with chronic or acute cholecystitis episodes. Case presentation We present the case of an 80 year old female with abdominal pain, inability to defecate and recurrent episodes of diarrhea for the past 8 months. CT examination uncovered a cholecystoduodenal fistula along with gas in the gall bladder and the presence of a ≥2 cm gallstone inside the small bowel lumen causing obstruction. Patient was admitted to the operating room, where a 3.2 cm gallstone was located in the terminal ileus. A rupture was found in the antimesenteric part of a discolored small bowel segment, approximately 60 cm from the ileocaecal valve, through which the gallstone was recovered. The bowel regained its peristalsis, and the rupture was debrided and sutured. Patient was discharged uneventfully on the 6th postoperative day. Discussion Gallstone ileus is caused due to the impaction of a gallstone inside the bowel lumen. It usually passes through a fistula connecting the gallstone with the gastrointestinal tract. It can present with nonspecific or acute abdominal symptoms. CT usually confirms the diagnosis, while there are a number of treatment options; conservative, minimal invasive and surgical. Our patient was successfully relieved of the obstruction through recovery of the gallstone using open surgery, with no repair of the fistula. Conclussion Although rare, gallstones must be suspected as a possible cause of bowel obstruction, especially in elderly patients reporting biliary symptoms.
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Affiliation(s)
| | | | - Panagiotis Dimas
- Department of Radiology, 401 Army General Hospital of Athens, Greece
| | - Alexandros Tassos
- 1st Department of Surgery, 401 Army General Hospital of Athens, Greece
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