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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

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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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