Comparison between surgical techniques in gallstone ileus and outcomes.

INTRODUCTION: Gallstone ileus is a rare cause of mechanical bowel obstruction, generally found in elderly patients who often have other significant medical conditions. OBJECTIVE: The objective of the study was to determine the prevalence of gallstone ileus and the number of postsurgical complications and outcomes depending on what type of surgical management is performed. METHOD: Cohort, retrospective, observational, and comparative study was conducted, which included 31 patients undergoing surgery for gallstone ileus. Three groups were integrated according to the type of surgical procedure: Group 1: enterotomy and stone extraction alone,. Group 2: enterotomy and cholecystectomy with fistula closure, and Group 3: bowel resection alone. RESULTS: A total of 31 patients were analyzed. Gallstone ileus represented the 1.44% of all cases of bowel obstruction. Complication rates were similar between three groups. Mortality rate was lower in Group A, especially when compared to Group B, with a statistically significant difference (p < 0.05). CONCLUSIONS: Surgery is the pillar in treatment of gallstone ileus. Enterotomy with stone extraction alone appears to be associated with a lower mortality rate and better outcomes when compared to more extensive techniques.

ANTECEDENTES: El íleo biliar es una causa rara de obstrucción intestinal mecánica, que se presenta generalmente en pacientes ancianos que a menudo tienen otras afecciones médicas importantes. OBJETIVO: Determinar la prevalencia del íleo biliar, el número de complicaciones y los resultados según el tipo de tratamiento quirúrgico que se realice. MÉTODO: Estudio de cohorte, retrospectivo, observacional y comparativo, que incluyó 31 pacientes sometidos a cirugía por íleo biliar. Se integraron tres grupos según el tipo de procedimiento quirúrgico: grupo 1, enterotomía y extracción de cálculos únicamente; grupo 2, enterotomía y colecistectomía con cierre de fístula; y grupo 3, resección intestinal únicamente. RESULTADOS: Se analizaron 31 pacientes. El íleo biliar representó el 1.44% de todos los casos de obstrucción intestinal. Las tasas de complicaciones fueron similares en los tres grupos. La tasa de mortalidad fue menor en el grupo 1, en especial cuando se comparó con el grupo 2, con una diferencia estadísticamente significativa (p < 0.05). CONCLUSIONES: La cirugía es el pilar en el tratamiento del íleo biliar. La enterotomía con extracción de cálculos parece asociarse con una menor tasa de mortalidad y mejores resultados en comparación con técnicas más extensas.

[Gallstone ileus after endoscopic retrograde cholangiopancreatography]. / Íleo biliar posterior a colangiopancreatografía retrógrada endoscópica.

BACKGROUND: Gallstone ileus is caused by the exit of a gallstone from the gallbladder or bile duct into the small intestine, resulting in bowel obstruction if this stone becomes lodged in a small bowel loop. CLINICAL CASE: The case is presented of a 78 year-old woman with an episode of intestinal obstruction. After studying the main cause of the obstruction, it was decided to perform a laparotomy where a gallstone located in the terminal ileum was causing the obstruction. No fistula was observed between the gallbladder and the bile duct and the intestinal tract. It is important to note the history of an endoscopic retrograde cholangiopancreatography performed a few months earlier, as it would probably be the cause of the passage of the gallstone to the small bowel. CONCLUSION: Few reports of gallstone ileus have been described in the literature after performing an endoscopic retrograde cholangiopancreatography. In these cases, the intestinal obstruction usually occurs several months after the endoscopic retrograde cholangiopancreatography, so the diagnosis is often delayed. Surgery is usually the definitive treatment and it consists of the removal the stone by enterotomy and performing a cholecystectomy. Biliary enteric fistula repair is not necessary since this does not form.

[Gallstone ileus, experience in the Dr. Eduardo Liceaga General Hospital of Mexico]. / Íleo biliar, experiencia en el Hospital General de México Dr. Eduardo Liceaga.

BACKGROUND: Gallstone ileus is a rare cause of intestinal obstruction (1-4%). It results from the migration of a gallstone through a bilio-enteric fistula. Treatment begins with fluid therapy, followed by enterolithotomy, fistula closure, and cholecystectomy. OBJECTIVES: To determine the clinical presentation in patients with gallstone ileus and subsequent medical -surgical management outcomes. MATERIAL AND METHODS: A retrospective, observational, descriptive and transversal study was conducted on patients diagnosed with intestinal obstruction secondary to a gallstone ileus from May 2013 to October 2014. The following variables were recorded: age, sex, comorbidities, mean time of onset of symptoms, length of preoperative and postoperative stay, imaging studies, biochemical tests, type of surgical management, stone location and size, complications, mortality, and postoperative follow-up. RESULTS: The study included 10 patients (male: female ratio 1:4), with a mean age of 61.9 years. The mean time of onset symptoms 15.4 days, and preoperative stay was 2days. On admission, 80% of patients had leukocytosis and neutrophilia, and 70% with renal failure. The most common surgical management was enterolithotomy with primary closure (50%), finding 80% of the stones in the terminal ileum. Recurrence was found in 2 cases. Mean postoperative hospital stay was 6.3 days. Mortality was 20%. CONCLUSIONS: Gallstone ileus most commonly presented in women in the seventh decade of life, with intermittent bowel obstruction. On hospital admission, they presented with systemic inflammatory response, electrolyte imbalance and abnormal liver function tests. Initial treatment must include fluid-electrolyte replacement, and tomography scans must be made in all cases. In our experience, the best procedure is enterolithotomy and primary closure, which presented lower morbidity and mortality.

Ileo biliar: presentación de un caso y revisión de literatura / Biliary obstruction: presentation of a case and review of literature

Este trabajo presenta un caso de Ileo Biliar en paciente femenino de 75 años, con enfermedad de 4 días de evolución caracterizada por vómitos incontables de aspecto fecaloideo, ausencia de evacuaciones y dolor abdominal tipo cólico. Se llevó a mesa operatoria evidenciando cálculo atascado de 5 cm de longitud por 3 cm de ancho en ileon distal a 25 cm de la válvula ileocecal, con dilatación proximal de asas delgadas. Se realiza extracción del mismo mediante enterotomía y enterorrafía en dos planos. La paciente presenta evolución satisfactoria. El ileo biliar es causa de obstrucción intestinal poco frecuentre, aparece generalmente en mujeres de más de 60 años. El cálculo biliar pasa generalmente a intestino, a través de la fistulización de la pared biliar en duodeno o yeyuno, tras prolongado decúbito, produciendo la neumatización del arbol biliar. Posteriormente el cálculo emigra hasta íleon distal, donde puede quedar detenido y provocar un cuadro de obstrucción de intestino delgado.