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Gallstone Ileus

      A 78-year-old woman was admitted to the hospital with a 14-day history of nausea, vomiting, and dehydration. Physical examination revealed no fever or peritonitis. Laboratory studies indicated leukocytosis (white blood cell count, 14.6 × 109/L). A plain abdominal x-ray film showed dilated small bowel loops (arrows). Conservative therapy for ileus was initiated. During hospitalization, abdominal pain and peritonitis developed. Exploratory laparotomy revealed 2 large obstructing gallstones (arrows) in the jejunum with adjacent small perforations and fecal contamination of the abdominal cavity. Both stones were removed by enterolithotomy and segmental resection. The cholecystoduodenal fistula was repaired, and cholecystectomy was performed. Review of the initial plain abdominal x-ray film showed air in the gallbladder (arrowheads). The postoperative period was complicated by anastomotic dehiscence that required repeated laparotomies. After a hospital stay of 24 weeks, the patient was discharged in good condition.
      In patients older than 65 years, gallstones cause 25% of all nonstrangulated small bowel obstructions,
      • Reisner RM
      • Cohen JR
      Gallstone ileus: a review of 1001 reported cases.
      whereas in the general population, ileus is a rare complication of gallstone disease. The diagnosis is often made intraoperatively, and mortality is high (8%-18%).
      • Reisner RM
      • Cohen JR
      Gallstone ileus: a review of 1001 reported cases.
      • Rodriguez Hermosa JI
      • Codina Cazador A
      • Girones Vila J
      • Roig Garcia J
      • Figa Francesch M
      • Acero Fernandez D
      Gallstone ileus: results of analysis of a series of 40 patients [in Spanish].
      • Pavlidis TE
      • Atmatzidis KS
      • Papaziogas BT
      • Papaziogas TB
      Management of gallstone ileus.
      Optimal surgical treatment is subject to some debate. When possible, a 1-stage procedure combining enterolithotomy, fistula repair, and cholecystectomy seems to be the treatment of choice.
      • Reisner RM
      • Cohen JR
      Gallstone ileus: a review of 1001 reported cases.
      • Rodriguez Hermosa JI
      • Codina Cazador A
      • Girones Vila J
      • Roig Garcia J
      • Figa Francesch M
      • Acero Fernandez D
      Gallstone ileus: results of analysis of a series of 40 patients [in Spanish].
      • Pavlidis TE
      • Atmatzidis KS
      • Papaziogas BT
      • Papaziogas TB
      Management of gallstone ileus.

      REFERENCES

        • Reisner RM
        • Cohen JR
        Gallstone ileus: a review of 1001 reported cases.
        Am Surg. 1994; 60: 441-446
        • Rodriguez Hermosa JI
        • Codina Cazador A
        • Girones Vila J
        • Roig Garcia J
        • Figa Francesch M
        • Acero Fernandez D
        Gallstone ileus: results of analysis of a series of 40 patients [in Spanish].
        Gastroenterol Hepatol. 2001; 24: 489-494
        • Pavlidis TE
        • Atmatzidis KS
        • Papaziogas BT
        • Papaziogas TB
        Management of gallstone ileus.
        J Hepatobiliary Pancreat Surg. 2003; 10: 299-302