Gallstone ileus

Gallstone ileus, a type of intestinal obstruction, is a surgical emergency affecting primarily elderly patients. The authors report their experience treating 37 patients with gallstone ileus over a 12-year period, with an average follow-up of 6.2 years. The ratio of women to men was 8:1 and the average age was 78 years. Symptoms, which were usually abdominal pain and vomiting, began about five days before hospital admission, reflecting the movement of the stone until it finally became impacted, or lodged in a particular place. Location of the impaction determined the type of vomit and related symptoms. Proximal obstruction produced vomitus containing bile and abdominal bloating, whereas more distal obstruction produced vomitus with fecal content and intestinal distention. Other serious diseases were present in 62 percent of patients. There were 16 patients (43 percent) who had some past history of gallbladder disease, but only three patients (8 percent) had cholecystitis (inflammation of the gallbladder) within the past year. The impacted stone was found in the terminal ileum (distal portion of the small intestine) in 73 percent of patients. More than one stone was found in six cases. A one-stage surgical procedure was performed on 8 patients, with two deaths; a two-stage procedure with delayed elective gallbladder surgery was performed on six patients with no deaths; and 23 patients had only stone removal with five deaths. The one-stage procedure is recommended when possible to avoid the necessity of giving anesthesia twice, and also because elderly patients often refuse two consecutive operations. Non-operative methods should be considered if the patient is a poor surgical risk. (Consumer Summary produced by Reliance Medical Information, Inc.)