• Humans
• Female
• Male
• Retrospective Studies
• Aged
• Gallstones/surgery
• Gallstones/complications
• Ileus/etiology
• Ileus/surgery
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Cholecystectomy/methods
• Patient Readmission/statistics & numerical data
• Length of Stay/statistics & numerical data
• Middle Aged
• Aged, 80 and over

• case report
• entero-biliary fistulae
• gallstone ileus
• gallstones complication
• gastrointestinal ileus
• gastrointestinal obstruction
• laparoscopic-assisted enterolithotomy

• Bezoar
• Gall stone ileus
• Obturator hernia
• Paraduodenal hernia
• Small bowel obstruction
• Superior mesenteric artery syndrome
• Unusual causes

• Humans
• Intestinal Obstruction/diagnostic imaging
• Intestinal Obstruction/etiology
• Intestine, Small/diagnostic imaging
• Checklist
• Diagnosis, Differential

• Humans
• Gallstones/complications
• Gallstones/surgery
• Gallbladder Diseases/complications
• Gallbladder Diseases/surgery
• Cholangitis/etiology
• Cholangitis/surgery
• Biliary Tract
• Surgeons
• Acute Disease

• Bowel obstruction
• Cholecystoduodenal fistula
• Gallstone ileus
• Pneumobilia
• Rigler's triad

• Bariatric surgery
• Bilio-digestive fistula
• Case report
• Enterolithotomy
• Gallstone ileus
• Intestinal occlusion
• One anastomosis gastric bypass

• ACS-NSQIP
• Cholecystectomy
• Gallstone ileus
• General surgery
• Outcomes

Gallstone ileus is a rare complication of gallstone disease in which a stone enters the enteric lumen and causes mechanical obstruction usually by bilioenteric fistula. Gallstone ileus accounts for 25% of all bowel obstructions among the population > 65 years of age. Despite medical advances over the last decades, gallstone ileus is still associated with high rates of morbidity and mortality.

An 89-year-old man with a history of gallstones was admitted to the Gastroenterology Department of our hospital, complaining of vomiting and cessation of bowel movements and flatus. Abdominal computed tomography showed cholecystoduodenal fistula and upper jejunum obstruction due to gallstones, pneumatosis in the gallbladder, and pneumobilia indicating Rigler’s triad. Considering the high risk of surgical management, we performed propulsive enteroscopy and laser lithotripsy twice to relieve the bowel occlusion. However, the intestinal obstruction was not relieved by the less invasive procedure. Then, the patient was transferred to the Department of Biliary-pancreatic Surgery. The patient underwent the one-stage procedure including laparoscopic duodenoplasty (fistula closure), cholecystectomy, enterolithotomy, and repair. After surgery, the patient presented with complications of acute renal failure, postoperative leak, acute diffuse peritonitis, septicopyemia, septic shock, and multiple organ failure, and finally died.

Early surgical intervention is the mainstay of treatment for gallstone ileus. For elderly patients with significant comorbidities, enterolithotomy alone is advised.

• Gallstone ileus
• Cholecystoduodenal fistula
• Pneumobilia
• Small bowel obstruction
• Case report

• cholecystoduodenal fistula
• cholecystoenteric fistula
• enterolithotomy
• gallstone diseases
• gallstones complication
• internal biliary fistula

• Bouveret syndrome
• Enterolithotomy
• Gallstone ileus
• Intestinal obstruction

Gallstone ileus is caused by an impaction of one or more gallstones within the gastrointestinal tract, leading to mechanical intestinal obstruction. It is a rare complication of cholelithiasis leading to the formation of a cholecystoenteric fistula and is associated with high mortality rates. We report a case of atypical subacute small bowel obstruction due to gallstone ileus.

An 82-year-old man, with previously diagnosed cholelithiasis, presented with abdominal pain and vomiting for nine days. The contracted gallbladder with distended bowel loops was visualized on abdominal ultrasound. Computed tomography of the abdomen and pelvis revealed dilated loops of the small intestine with a gallstone in the proximal ileum, causing intestinal obstruction with pneumobilia, suggesting gallstone ileus with cholecystoduodenal fistula. The patient underwent an emergency laparotomy and enterolithotomy to remove the impacting gallstone. The cholecystoduodenal fistula was left undisturbed due to the significant risk of duodenal injury. The patient had an uneventful postoperative recovery.

Gallstone ileus almost always requires surgical management. However, performing an interval biliary surgery is based on the clinical judgment of the surgeon. In our case, the patient's clinical status determined the treatment in which an enterotomy with stone extraction alone was largely sufficient, and has supported the literature. Gallstone ileus is an important differential diagnosis in elderly patients with gallstone disease, untreated or undiagnosed, presenting with features of small bowel obstruction.

•

Gallstone ileus is a rare cause of small bowel obstruction, commonly in the elderly.

Gallstone ileus is caused by an impaction of one or more gallstones within the gastrointestinal tract leading to mechanical intestinal obstruction. It is a rare complication of cholelithiasis and found in 2–3% of all cases associated with recurrent episodes of cholecystitis. This case study demonstrates an atypical presentation of gallstone ileus. A 57-year-old woman was presented with abdominal pain and vomiting without previous history of gallstone disease. The features of gallstone ileus are evident on computed tomography. She underwent an emergency laparotomy and enterotomy for the removal of impacting gallstones, followed by an interval cholecystectomy and cholecystoduodenal fistula closure. This case report aims to explore the proper surgical management of gallstone ileus. Unfortunately, the question of whether interval biliary surgery should be performed remains unanswered, and surgeons will continue to make the decision based on their clinical judgement.

Cholecystocolic fistulas are uncommon, with rare cases of colonic obstruction described in the literature and even rarer cases of intestinal perforation due to gallstones.

We describe a case of a 73-year-old man who presented to our ED with complaints of diffuse abdominal pain, vomiting, constipation, and fever for the past week. Abdomen CT showed signs of acute perforated appendicitis. An exploratory laparotomy was proposed which revealed cecal perforation caused by a 3 cm gallstone. A right colectomy was performed with primary anastomosis, without cholecystectomy or fistula repair. The postoperative period was complicated due to an anastomotic dehiscence on day 12 with the need for a re-laparotomy with an ileotransverse colostomy confection. The patient was in the ICU care for five days and was discharged on the 13th day after the second intervention. 

The clinical presentation of gallstone ileus is nonspecific and vague often leading to a delay in the diagnosis and treatment. CT scan has the best specificity and sensibility for the diagnosis but abdominal X-ray may show the pathognomonic Rigler´s triad. The surgical treatment consists of removing the gallstone with or without simultaneous cholecystectomy and fistula repair.

Reports of colonic perforation due to gallstones are very scarce, which makes this a very low suspicion diagnosis. The ideal surgical approach is not established. The morbidity of these cases can reach 50%.

• cholecystocolic fistula
• colonic perforation
• gallstone colonic obstruction
• rigler´s triad

Background Gallstone ileus is an important complication of cholecystolithiasis. In general, surgery is the treatment of choice for such cases, but clinicians face difficulty in the selection of an appropriate approach. Closure of a cholecystoenteric fistula can be achieved through one-stage or two-stage operation. Two-stage operation has a lower mortality rate than a one-stage procedure, but persistence of the cholecystoenteric fistula is associated with the risk of carcinogenesis and recurrence of gallstone ileus.

Objective This study reviews the different surgical approaches according to the impaction site of the gallstone, using data of previous studies by our group and clinical reports in the literature.

Conclusions First, for cases involving impaction at the duodenum, the cholecystoenteric fistula can be repaired in the same surgical field, and one-stage operation obtains favourable outcome; hence, one-stage operation is considered as treatment of choice. Second, for cases involving impaction at the small intestine, natural closure of the cholecystoenteric fistula or low mortality is expected; hence, two-stage operation may be performed, possibly using minimally invasive laparoscopy. Third, for cases involving impaction at the colon, natural closure of the cholecystocolonic fistula is unlikely, and patients have a high risk of reflux cholangitis due to faecal fluid; hence, one-stage operation is considered as treatment of choice.

• abdominal surgery
• gallstone disease
• small bowel disease

• biliary ileus
• diagnosis
• endoscopy
• gallstone
• laparoscopy
• treatment

• Aged
• Aged, 80 and over
• Female
• Gallstones/complications
• Gallstones/diagnosis
• Gallstones/therapy
• Humans
• Ileus/diagnosis
• Ileus/etiology
• Ileus/therapy
• Laparoscopy/methods
• Middle Aged
• Tomography, X-Ray Computed

• Aged, 80 and over
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholecystectomy
• Gallstones/etiology
• Humans
• Ileus/etiology
• Male
• Postoperative Complications/etiology
• Sphincterotomy, Endoscopic/adverse effects

• Cholecystectomy
• cholecystolithotomy
• gallstone
• ileus
• recurrent

• Case report
• Cholecystoduodenal fistula
• Enterotomy
• Gallbladder stones
• Gallstone ileus
• Intestinal obstruction

• Bilioenteric fistula
• Bouveret syndrome
• Bowel obstruction
• Gallstone ileus

Gallstone ileus is an uncommon cause of intestinal obstruction and occurs following the formation of a cholecystoenteric fistula, permitting passage of gallstones into the gastrointestinal tract. Impaction of a gallstone in the sigmoid colon is rare and is usually at sites of previous colonic disease. Definitive management can be challenging due to the advanced age and co-morbidity usually seen in this group of patients. We describe a patient successfully managed with on-table endoscopy and, under local anaesthetic, the formation of a left iliac fossa trephine loop colostomy, permitting an enterolithotomy to deliver the stone whilst accommodating for severe pre-existing distal sigmoid diverticular disease. A review of the literature identified various endoscopic and surgical treatments that, depending on local expertise and patient characteristics, can be considered on a case-by-case basis. We advocate the management described in this case for patients presenting with large bowel obstruction due to gallstone ileus, with a background of diverticular disease and who are not fit for general anaesthetic or formal bowel resection, as an alternative to medical palliation alone.

• Bowel obstruction
• Cholecystoenteric fistula
• Gallstone
• Ileus
• Sigmoid
• Trephine loop colostomy

Gallstone ileus (GI) is a mechanical obstruction of small or large bowel caused by gallstone passed to the intestinal lumen through spontaneous or postoperative biliodigestive fistula. A 42-year-old female patient was admitted with the clinical presentation of small bowel obstruction. She underwent hepaticojejunostomy 4 years prior to admission for primary sclerosing cholangitis. Barium meal follows through revealed Rigler's triad. The patient underwent laparotomy which revealed GI. A “stone on a suture” was removed through enterotomy. Patients after cholecystectomy and hepaticojejunostomy can develop GI. Nonabsorbable suture used to create biliodigestive anastomosis can appear to become the frame of a “stone on a suture.”

• Bouveret's syndrome
• enterolithotomy
• gallstone ileus
• hepaticojejunostomy
• small bowel obstruction

Gallstone ileus due to erosion of one or more gallstones into the gastrointestinal tract is an uncommon cause of small bowel obstruction. The site of impaction is usually distal ileum, and less commonly the jejunum, colon, duodenum, or stomach. We report a rare case of gallstone ileus with impaction at the proximal small bowel and at a Meckel’s diverticulum (MD) in a 64-year-old woman managed with laparoscopic converted to open small bowel resections. Patient was discharged home in stable condition and remained asymptomatic at 6-mo follow up. We review the current literature on surgical approaches to MD and gallstone ileus. Diverticulectomy or segmental resection is preferred for complicated MD. For gallstone ileus, simple enterolithotomy or segmental resection are the most the most favored especially in older co-morbid patients due to lower mortality rates and the rarity of recurrent gallstone ileus. In addition, laparoscopy has been increasingly reported as a safe approach to manage gallstone ileus.

• Gallstone ileus
• Meckel’s diverticulum
• Small bowel obstruction
• Laparoscopy
• Cholecystoenteric fistula
• Laparoscopy

•

Gallstone ileus is seen in the elderly and has a high mortality rate.

Gallstone ileus is a complication of acute cholecystitis that accounts for 25% of bowel obstruction cases in the elderly. To our knowledge, only one other case of gallstone ileus presenting as intussusception has been reported in the literature, and involved non-operative management with an unfavorable outcome.

Here we report the case of 69 year old woman presenting with symptoms of acute small bowel obstruction with a surgical history significant for cholecystectomy 30 years prior. Computed tomographic imaging showed a target sign in the small bowel consistent with intussusception, but intraoperative diagnosis revealed this to be a gallstone. A simple enterolithotomy was conducted and the patient has since been symptom free.

Gallstone ileus has a high mortality rate (12–17%) and is an important differential diagnosis to consider, especially as the elderly population throughout the world continues to grow.

As radiographic features of gallstones are variable we suggest maintaining a high index of suspicion for gallstone ileus in any elderly patient presenting with SBO, even with a seemingly contradictory surgical history.

• Case report
• Gallstone ileus
• Geriatric surgery
• Hepatobiliary
• Intussusception
• Small bowel obstruction

• Bilio-enteric fistula
• Cholelithiasis
• Colelitiasis
• Fístula bilioentérica
• Gallstone ileus
• Intestinal obstruction
• Obstrucción intestinal
• Íleo biliar

Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract. Less than 1% of cases of intestinal obstruction are derived from this etiology. The symptoms and signs of gallstone ileus are mostly nonspecific. This entity has been observed with a higher frequency among the elderly, the majority of which have concomitant medical illness. Cardiovascular, pulmonary, and metabolic diseases should be considered as they may affect the prognosis. Surgical relief of gastrointestinal obstruction remains the mainstay of operative treatment. The current surgical procedures are: (1) simple enterolithotomy; (2) enterolithotomy, cholecystectomy and fistula closure (one-stage procedure); and (3) enterolithotomy with cholecystectomy performed later (two-stage procedure). Bowel resection is necessary in certain cases after enterolithotomy is performed. Large prospective laparoscopic and endoscopic trials are expected.

• Intestinal obstruction
• Bouveret’s syndrome
• Laparoscopic surgery
• Endoscopic treatment
• Gallstone ileus

Enterolithiasis or formation of gastrointestinal concretions is an uncommon medical condition that develops in the setting of intestinal stasis in the presence of the intestinal diverticula, surgical enteroanastomoses, blind pouches, afferent loops, incarcerated hernias, small intestinal tumors, intestinal kinking from intra-abdominal adhesions, and stenosing or stricturing Crohn’s disease and intestinal tuberculosis. Enterolithiasis is classified into primary and secondary types. Its prevalence ranges from 0.3% to 10% in selected populations. Proximal primary enteroliths are composed of choleic acid salts and distal enteroliths are calcified. Clinical presentation includes abdominal pains, distention, nausea, and vomiting of occasionally sudden but often fluctuating subacute nature which occurs as a result of the enterolith tumbling through the bowel lumen. Thorough history and physical exam coupled with radiologic imaging helps establish a diagnosis in a patient at risk. Complications include bowel obstruction, direct pressure injury to the intestinal mucosa, intestinal gangrene, intussusceptions, afferent loop syndrome, diverticulitis, iron deficiency anemia, gastrointestinal hemorrhage, and perforation. Mortality of primary enterolithiasis may reach 3% and secondary enterolithiasis 8%. Risk factors include poorly conditioned patients with significant obstruction and delay in diagnosis. Treatment relies on timely recognition of the disease and endoscopic or surgical intervention. With advents in new technology, improved outcome is expected for patients with enterolithiasis.

• Enterolithiasis
• Gallstone ileus
• Intestinal obstruction
• Crohn’s disease
• Meckel’s diverticulum
• Diverticulosis
• Intestinal tuberculosis

• Animals
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/history
• Gastrointestinal Diseases/mortality
• Gastrointestinal Diseases/physiopathology
• Gastrointestinal Diseases/therapy
• History, 17th Century
• History, 20th Century
• Humans
• Lithiasis/diagnosis
• Lithiasis/history
• Lithiasis/mortality
• Lithiasis/physiopathology
• Lithiasis/therapy
• Predictive Value of Tests
• Risk Factors
• Treatment Outcome

•

An 86-year-old woman with a history of cholelithiasis presented with abdominal pain and nausea.

Herein we present the case of an 86-year-old woman with gallstone perforation of the sigmoid colon.

An 86-year-old woman with known cholelithiasis presented to our office with one week of abdominal pain and nausea. X-rays taken at presentation demonstrated pneumobilia, and CT scan showed a 3.5 cm gallstone in the sigmoid colon. Medical management was unsuccessful in passing the stone, and a colonoscopy on day 4 was unsuccessful in incorporating the stone. Subsequent clinical deterioration prompted a laparotomy, where a perforation was discovered. A Hartmann's procedure was performed and the patient recovered after a complicated post-operative course.

Gallstone ileus is an uncommon, but medically important, cause of bowel obstruction. This presentation is considered a surgical emergency and thus prompt identification and removal is essential. Obstructions tend to occur in either the stomach or along the various segments of the small intestine but have been reported in the colon as well.

In cases of gallstones that manage to pass into the large intestine, it is prudent to attempt conservative measures for passage. Failure to do so should raise suspicion of a possible stricture, either benign or malignant, preventing its evacuation. Earlier surgical intervention should be considered in these cases.

• Colon
• Gallstone
• Obstruction
• Perforation
• Sigmoid

• Complications
• Fistula
• Gallstones
• Lost stones
• Obstruction

• Gallstone ileus
• pneumobilia
• rigler's triad
• small bowel obstruction

Metastatic breast cancer to the small bowel (SB) presenting as gallstone ileus and resulting in SB obstruction has not been described previously. A 76-year-old woman with previous metastatic breast cancer to the axial spine and hips presented with abdominal pain and bilious vomiting. CT scanning revealed SB obstruction consistent with gallstone ileus. The patient underwent two segmental SB resections for distal ileal strictures mimicking what appeared to be macroscopic Crohn's disease. The entero-biliary fistula was undisturbed. Pathological analysis revealed the dual pathologies of gallstone ileus and metastatic carcinoma from a breast primary causing luminal SB obstruction. Improvements in staging and treatment modalities have contributed to the increased overall long-term survival for breast cancer, compelling clinicians to consider metastatic breast cancer as a differential diagnosis in women presenting with new onset of gastrointestinal symptoms in order that appropriate treatment be administered in a timely fashion.

Gallstone ileus is a rare cause of gastrointestinal obstruction, more frequent in elderly patients, whose treatment is essentially surgical, although some para-surgical and mini-invasive possibilities exist, allowing the solution of such obstructive condition in a completely non-invasive way.

In our study, after reporting two cases of biliary ileus managed by our surgical division, we will analyze the most suitable diagnostic procedures and the therapeutic approaches to this pathology.

Gallstone ileus is a quite rare pathology in population, but affects more frequently elderly people; The treatment of this disease is mainly surgical.

• Abdomen agudo
• Acute abdomen
• Gallstone ileus
• Intestinal obstruction
• Obstrucción intestinal
• Íleo biliar

Gallstone ileus (GI) is characterized by occlusion of the intestinal lumen as a result of one or more gallstones. GI is a rare complication of gallstones that occurs in 1%-4% of all cases of bowel obstruction. The mortality associated with GI ranges between 12% and 27%. Classical findings on plain abdominal radiography include: (1) pneumobilia; (2) intestinal obstruction; (3) an aberrantly located gallstone; and (4) change of location of a previously observed stone. The optimal management of acute GI is controversial and can be: (1) enterotomy with stone extraction alone; (2) enterotomy, stone extraction, cholecystectomy and fistula closure; (3) bowel resection alone; and (4) bowel resection with fistula closure. We describe a case to highlight some of the pertinent issues involved in GI management, and propose a scheme to minimize recurrent disease and postoperative complications. We conclude that GI is a rare condition affecting mainly the older population with a female predominance. The advent of computed tomography and magnetic resonance imaging has made it easier to diagnose GI. Enterotomy with stone extraction alone remains the most common surgical method because of its low incidence of complications.

• Gallstone ileus
• Fistula closure
• Intestinal obstruction
• Bowel obstruction
• Enterolithotomy

• Female
• Gallstones/complications
• Gallstones/surgery
• Humans
• Ileus/etiology
• Ileus/surgery
• Middle Aged