Gallstone ileus as an unexpected complication of cholelithiasis: diagnostic difficulties and treatment

BACKGROUND
Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. The aim of this study was to evaluate our experience with 12 gallstone ileus cases and discuss current opinion as reported in the literature.
METHODS
Data of 12 patients operated between January 1998 and January 2008 with gallstone ileus were retrospectively studied.
RESULTS
There were 12 cases (9 F, 75%; 3 M, 25%) with a mean age of 63.6 (50-80) years. Median duration of symptoms before admission to the hospital was 4.1 (1-15) days. Preoperative diagnosis was made in only five cases (41.6%). Enterolithotomy was done in nine cases (75%). Enterolithotomy and resection of the small intestine - required for decubital necrosis from the gallstone - was performed in one case (8.3%). In one case (8.3%), enterolithotomy was completed in one stage with cholecystectomy and closure of the fistula during acute surgery, and in another case (8.3%), enterolithotomy + primary suturing of the jejunal perforation was performed. There were two (16.6%) perioperative mortalities.
CONCLUSION
Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Gallstone ileus should be suspected in all cases admitted to the emergency service with acute intestinal obstruction with a history of cholelithiasis, especially in the elderly and females.

Kolelitiazisin beklenmedik komplikasyonu, safra taþý ileusu: Taný zorluklarý ve tedavi

AMAÇ
Safra taþý ileusu safra taþý hastalýðýnýn nadir ve genelde yaþlýlarda görülen bir komplikasyonudur. Çalýþmamýzýn amacý safra taþý ileusu tanýsý alan 12 hastayla ilgili deneyimimizi deðerlendirmek ve güncel literatür eþliðinde tartýþmaktýr.
GEREÇ VE YÖNTEM
Kliniðimizde Ocak 1998-2008 yýllarý arasýnda safra taþý ileusu nedeniyle ameliyat edilen 12 olgunun dosyalarý retrospektif olarak incelendi.
BULGULAR
Hastalarýn 9’u (%75) kadýn, 3’ü (%25) erkek olup ortalama yaþ 63,6 idi (daðýlým, 50-80). Semptomlarýn baþlamasýndan hastaneye baþvurmaya kadar geçen süre ortalama 4,1 (daðýlým, 1-15) gün bulundu. Preoperatif taný sadece 5 (%41,6) olguda konuldu. Hastalarýn 9’una (%75) enterolitotomi, 1’ine (%8,3) enterolitotomi + ince baðýrsak rezeksiyonu, 1’ine (%8,3) tek aþamalý cerrahi, 1’ine (%8,3) ise enterolitotomi + jejunal perforasyona primer dikiþ ameliyatý uygulandý. Perioperatif mortalite 2 (%16.6) olguda görüldü.
SONUÇ
Görüntüleme tekniklerindeki ilerlemeye raðmen safra taþý ileusu halen tanýsal bir problemdir ve ameliyat öncesi taný genellikle gecikmektedir. Safra kesesi taþý öyküsü bulunan ve acil servise akut intestinal týkanýklýk bulgularýyla baþvuran özellikle yaþlý ve kadýn hastalarda safra taþý ileusu akýlda tutulmalýdýr.