Gallstone ileus diagnosis and treatment: six-year experience in three academic institutions

Background: Gallstone ileus is defined as a mechanical intestinal obstruction due to impaction of one or more gallstones within the gastrointestinal tract. It occurs most frequently in elderly patients, and accounts for 1%-4% of mechanical intestinal obstructions. The mainstay of treatment is surgical exploration. Methods: We present a retrospective review of patients with gallstone ileus, treated during 2015-2020, in three western academic centers in Mexico. The aim of this study was to describe the clinical manifestations, radiological and operative findings, surgical treatment and postoperative outcomes. Results: The study included sixteen patients. Seventy five percent of patients were female and the overall median age was 55 years (range 26-81). Clinical presentation included abdominal pain (93.7%), vomit (81.2%), abdominal distention and impossibility to pass feces and flatus (68.7%). Classical image findings were observed on plain abdominal radiographs (43.7%), ultrasound (37.5%) and computed tomography (81.2%). All patients underwent surgical treatment. The terminal ileum was the most common site of impaction (75%). The most frequent fistula was cholecystoduododenal (75%). Enterotolithotomy alone was performed in 68.7% of patients, and one-stage-procedure in 31.2%. Overall morbidity rate and morality rates were 75% and 12.5%, respectively. Conclusions: Gallstone ileus is a rare cause of gastrointestinal obstruction, with female and elderly population preponderance, although younger patients are affected. A high clinical index of suspicion guides image modality selection, where CT is the most useful image used. Enterolithotomy alone is the most frequent surgical approach, with a lower morbidity rate. Indications for a one-stage surgical approach remain to be established.

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