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Gallstone Ileus

  • Chris Dodgion
  • Marc de Moya
Chapter

Abstract

Gallstone ileus is a mechanical obstruction of the gastrointestinal tract caused by gallstones that enter the alimentary tract via a cholecystoenteric fistula. It occurs in less than 1% of bowel obstructions and 0.3% of patients with cholelithiasis. There is an increased rate of diagnosis in the elderly, >65 years old, with female predominance (3:1). Presentation is often delayed due to intermittent symptoms. Abdominal CT scan has supplanted both abdominal X-rays and ultrasound as the most sensitive diagnostic test of choice. While cases have been reported of successful lithotripsy with endoscopic retrieval, surgical intervention is still the gold standard of treatment. Enterolithotomy alone is the most common operation performed due to historically lower rates of mortality and morbidity, but controversy remains regarding the utility of laparoscopic approaches and interventions to address the biliary fistula (131 words).

Keywords

Gallstone ileus Cholecystoenteric fistula Intestinal obstruction Enterolithotomy 

References

  1. 1.
    Deitz DM, Standage BA, Pinson CW, McConnell DB, Krippaehne WW. Improving the outcome in gallstone ileus. Am J Surg. 1986;151(5):572–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Halabi WJ, Kang CY, Ketana N, Lafaro KJ, Nguyen VQ, Stamos MJ, Imagawa DK, Demirjian AN. Surgery for gallstone ileus: a nationwide comparison of trends and outcomes. Ann Surg. 2014;259(2):329–35.PubMedCrossRefGoogle Scholar
  3. 3.
    Reisner RM, Cohen JR. Gallstone ileus: a review of 1001 reported cases. Am Surg. 1994;60(6):441–6.PubMedGoogle Scholar
  4. 4.
    Clavien PA, Richon J, Burgan S, Rohner A. Gallstone ileus. Br J Surg. 1990;77(7):737–42.PubMedCrossRefGoogle Scholar
  5. 5.
    van Hillo M, van der Vliet JA, Wiggers T, Obertop H, Terpstra OT, Greep JM. Gallstone obstruction of the intestine: an analysis of ten patients and a review of the literature. Surgery. 1987;101(3):273–6.PubMedGoogle Scholar
  6. 6.
    Nuño-Guzmán CM. Gallstone ileus, clinical presentation, diagnostic and treatment approach. World J Gastrointest Surg. 2016;8(1):65–13.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Deckoff SL. Gallstone ileus; a report of 12 cases. Ann Surg. 1955;142(1):52–65.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Cooperman AM, Dickson ER, ReMine WH. Changing concepts in the surgical treatment of gallstone ileus: a review of 15 cases with emphasis on diagnosis and treatment. Ann Surg. 1968;167(3):377–83.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Ayantunde AA, Agrawal A. Gallstone ileus: diagnosis and management. World J Surg. 2007;31(6):1292–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Mallipeddi MK, Pappas TN, Shapiro ML, Scarborough JE. Gallstone ileus: revisiting surgical outcomes using National Surgical Quality Improvement Program data. J Surg Res. 2013;184(1):84–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172–87.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Day EA, Marks C. Gallstone ileus. Review of the literature and presentation of thirty-four new cases. Am J Surg. 1975;129(5):552–8.PubMedCrossRefGoogle Scholar
  13. 13.
    VanLandingham SB, Broders CW. Gallstone ileus. Surg Clin North Am. 1982;62(2):241–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Moss JF, Bloom AD, Mesleh GF, Deziel D, Hopkins WM. Gallstone ileus. Am Surg. 1987;53(8):424–8.PubMedGoogle Scholar
  15. 15.
    Chou J-W, Hsu C-H, Liao K-F, Lai H-C, Cheng K-S, Peng C-Y, Yang M-D, Chen Y-F. Gallstone ileus: report of two cases and review of the literature. World J Gastroenterol. 2007;13(8):1295–8.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Masannat Y, Masannat Y, Shatnawei A. Gallstone ileus: a review. Mt Sinai J Med. 2006;73(8):1132–4.PubMedGoogle Scholar
  17. 17.
    Rigler LG, Borman CN, Noble JF. Gallstone obstruction: pathogenesis and roentgen manifestations. J Am Med Assoc. 1941;117(21):1753–9.CrossRefGoogle Scholar
  18. 18.
    Balthazar EJ, Schechter LS. Air in gallbladder: a frequent finding in gallstone ileus. AJR Am J Roentgenol. 1978;131(2):219–22.PubMedCrossRefGoogle Scholar
  19. 19.
    Ripollés T, Miguel-Dasit A, Errando J, Morote V, Gómez-Abril SA, Richart J. Gallstone ileus: increased diagnostic sensitivity by combining plain film and ultrasound. Abdom Imaging. 2001;26(4):401–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Lassandro F, Gagliardi N, Scuderi M, Pinto A, Gatta G, Mazzeo R. Gallstone ileus analysis of radiological findings in 27 patients. Eur J Radiol. 2004;50(1):23–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Gaduputi V, Tariq H, Rahnemai-Azar AA, Dev A, Farkas DT. Gallstone ileus with multiple stones: where Rigler triad meets Bouveret’s syndrome. World J Gastrointest Surg. 2015;7(12):394–7.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Wong CS, Crotty JM, Naqvi SA. Pneumobilia: a case report and literature review on its surgical approaches. J Surg Tech Case Rep. 2013;5(1):27–31.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Lasson A, Lorén I, Nilsson A, Nirhov N, Nilsson P. Ultrasonography in gallstone ileus: a diagnostic challenge. Eur J Surg. 1995;161(4):259–63.PubMedGoogle Scholar
  24. 24.
    Davies RJ, Sandrasagra FA, Joseph AE. Case report: ultrasound in the diagnosis of gallstone ileus. Clin Radiol. 1991;43(4):282–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Yu CY, Lin CC, Shyu RY, Hsieh CB, Wu HS, Tyan YS, Hwang JI, Liou CH, Chang WC, Chen CY. Value of CT in the diagnosis and management of gallstone ileus. World J Gastroenterol. 2005;11(14):2142–7.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Kirchmayr W, Mühlmann G, Zitt M, Bodner J, Weiss H, Klaus A. Gallstone ileus: rare and still controversial. ANZ J Surg. 2005;75(4):234–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Lassandro F, Romano S, Ragozzino A, Rossi G, Valente T, Ferrara I, Romano L, Grassi R. Role of helical CT in diagnosis of gallstone ileus and related conditions. AJR Am J Roentgenol. 2005;185(5):1159–65.PubMedCrossRefGoogle Scholar
  28. 28.
    Lorén I, Lasson A, Nilsson A, Nilsson P, Nirhov N. Gallstone ileus demonstrated by CT. J Comput Assist Tomogr. 1994;18(2):262–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Swift SE, Spencer JA. Gallstone ileus: CT findings. Clin Radiol. 1998;53(6):451–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Reimann AJ, Yeh BM, Breiman RS, Joe BN, Qayyum A, Coakley FV. Atypical cases of gallstone ileus evaluated with multidetector computed tomography. J Comput Assist Tomogr. 2004;28(4):523–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Delabrousse E, Bartholomot B, Sohm O, Wallerand H, Kastler B. Gallstone ileus: CT findings. Eur Radiol. 2000;10(6):938–40.PubMedCrossRefGoogle Scholar
  32. 32.
    Rodríguez-Sanjuán JC, Casado F, Fernández MJ, Morales DJ, Naranjo A. Cholecystectomy and fistula closure versus enterolithotomy alone in gallstone ileus. Br J Surg. 1997;84(5):634–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Berliner SD, Burson LC. One-stage repair for cholecyst-duodenal fistula and gallstone ileus. Arch Surg. 1965;90:313–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Warshaw AL, Bartlett MK. Choice of operation for gallstone intestinal obstruction. Ann Surg. 1966;164(6):1051–5.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Kasahara Y, Umemura H, Shiraha S, Kuyama T, Sakata K, Kubota H. Gallstone ileus. Review of 112 patients in the Japanese literature. Am J Surg. 1980;140(3):437–40.PubMedCrossRefGoogle Scholar
  36. 36.
    Muthukumarasamy G, Venkata SP, Shaikh IA, Somani BK, Ravindran R. Gallstone ileus: surgical strategies and clinical outcome. J Dig Dis. 2008;9(3):156–61.PubMedCrossRefGoogle Scholar
  37. 37.
    Tan YM, Wong WK, Ooi LLPJ. A comparison of two surgical strategies for the emergency treatment of gallstone ileus. Singap Med J. 2004;45(2):69–72.Google Scholar
  38. 38.
    Haq AU, Morris AH, Daintith H. Recurrent gall-stone ileus. Br J Radiol. 1981;54(647):1000–1.PubMedCrossRefGoogle Scholar
  39. 39.
    Levin B, Shapiro RA. Recurrent enteric gallstone obstruction. Gastrointest Radiol. 1980;5(2):151–3.PubMedCrossRefGoogle Scholar
  40. 40.
    Doogue MP, Choong CK, Frizelle FA. Recurrent gallstone ileus: underestimated. Aust N Z J Surg. 1998;68(11):755–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Mir SA, Hussain Z, Davey CA, Miller GV, Chintapatla S. Management and outcome of recurrent gallstone ileus: a systematic review. World J Gastrointest Surg. 2015;7(8):152–9.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Raiford TS. Intestinal obstruction caused by gallstones. Am J Surg. 1962;104:383–94.PubMedCrossRefGoogle Scholar
  43. 43.
    Anseline P. Colonic gall-stone ileus. Postgrad Med J. 1981;57(663):62–5.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Montgomery A. Laparoscope-guided enterolithotomy for gallstone ileus. Surg Laparosc Endosc. 1993;3(4):310–4.PubMedGoogle Scholar
  45. 45.
    Franklin ME Jr, Dorman JP, Schuessler WW. Laparoscopic treatment of gallstone ileus: a case report and review of the literature. J Laparoendosc Surg. 1994;4(4):265–72.PubMedCrossRefGoogle Scholar
  46. 46.
    Moberg AC, Montgomery A. Laparoscopically assisted or open enterolithotomy for gallstone ileus. Br J Surg. 2007;94(1):53–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Allen JW, McCurry T, Rivas H, Cacchione RN. Totally laparoscopic management of gallstone ileus. Surg Endosc. 2003;17(2):352.PubMedCrossRefGoogle Scholar
  48. 48.
    Owera A, Low J, Ammori BJ. Laparoscopic enterolithotomy for gallstone ileus. Surg Laparosc Endosc Percutan Tech. 2008;18(5):450–2.PubMedCrossRefGoogle Scholar
  49. 49.
    Sesti J, Okoro C, Parikh M. Laparoscopic enterolithotomy for gallstone ileus. J Am Coll Surg. 2013;217(2):e13–5.PubMedCrossRefGoogle Scholar
  50. 50.
    Behrens C, Amson B. Laparoscopic management of multiple gallstone ileus. Surg Laparosc Endosc Percutan Tech. 2010;20(2):e64–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Kim YG, Byeon J-S, Lee SK, Yang D-H, Kim K-J, Ye BD, Myung S-J, Yang S-K, Kim J-H. Gallstone ileus successfully treated with endoscopic fragmentation by using double-balloon endoscopy (with video). Gastrointest Endosc. 2011;74(1):228–30.PubMedCrossRefGoogle Scholar
  52. 52.
    Muratori R, Cennamo V, Menna M, Cecinato P, Eusebi LH, Mazzella G, Bazzoli F. Colonic gallstone ileus treated with radiologically guided extracorporeal shock wave lithotripsy followed by endoscopic extraction. Endoscopy. 2012;44(Suppl 2 UCTN (S 02)):E88–9.PubMedGoogle Scholar
  53. 53.
    Fujita N, Noda Y, Kobayashi G, Kimura K, Watanabe H, Shirane A, Hayasaka T, Mochizuki F, Yamazaki T. Gallstone ileus treated by electrohydraulic lithotripsy. Gastrointest Endosc. 1992;38(5):617–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Sackmann M, Holl J, Haerlin M, Sauerbruch T, Hoermann R, Heinkelein J, Paumgartner G. Gallstone ileus successfully treated by shock-wave lithotripsy. Dig Dis Sci. 1991;36(12):1794–5.PubMedCrossRefGoogle Scholar
  55. 55.
    Lowe AS, Stephenson S, Kay CL, May J. Duodenal obstruction by gallstones (Bouveret’s syndrome): a review of the literature. Endoscopy. 2005;37(1):82–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Bourke MJ, Schneider DM, Haber GB. Electrohydraulic lithotripsy of a gallstone causing gallstone ileus. Gastrointest Endosc. 1997;45(6):521–3.PubMedCrossRefGoogle Scholar
  57. 57.
    Meyenberger C, Michel C, Metzger U, Koelz HR. Gallstone ileus treated by extracorporeal shockwave lithotripsy. Gastrointest Endosc. 1996;43(5):508–11.PubMedCrossRefGoogle Scholar
  58. 58.
    Oakland DJ, Denn PG. Endoscopic diagnosis of gallstone ileus of the duodenum. Dig Dis Sci. 1986;31(1):98–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Zielinski MD, Ferreira LE, Baron TH. Successful endoscopic treatment of colonic gallstone ileus using electrohydraulic lithotripsy. World J Gastroenterol. 2010;16(12):1533–6.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Doko M, Zovak M, Kopljar M, Glavan E, Ljubicic N, Hochstädter H. Comparison of surgical treatments of gallstone ileus: preliminary report. World J Surg. 2003;27(4):400–4.PubMedCrossRefGoogle Scholar
  61. 61.
    Rodríguez Hermosa JI, Codina Cazador A, Gironès Vilà J, Roig García J, Figa Francesch M, Acero Fernández D. Gallstone ileus: results of analysis of a series of 40 patients. Gastroenterol Hepatol. 2001;24(10):489–94.PubMedCrossRefGoogle Scholar
  62. 62.
    Martinez Ramos D, Daroca Jose JM, Escrig Sos J, Paiva Coronel G, Alcalde Sanchez M, Salvador Sanchis JL. Gallstone ileus: management options and results on a series of 40 patients. Rev Esp Enferm Dig. 2009;101(2):117–20. 121-114.PubMedCrossRefGoogle Scholar
  63. 63.
    Corvera CU, Reza JA. Chapter 42: Biliary fistulae and strictures A2. In: Jarnagin WR, editor. Blumgart’s surgery of the liver, biliary tract and pancreas, 2-volume set. 6th ed. Philadelphia; 2017. p. 675–713.e679.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Trauma/Acute Care SurgeryMedical College of Wisconsin-Froedtert Trauma CenterMilwaukeeUSA

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