What Are the Treatments for Gallstone Ileus?

Gallstone ileus is an unusual complication of the bowel that affects older people.

Gallstone ileus is an unusual complication of the bowel. It is caused by an obstruction of more than one gallstone, about 2.5 centimeters in diameter, in the ileus or end portion of the small intestine. Gallstone ileus generally affects geriatric patients with pre-existing health disorders, such as hypertension and diabetes mellitus, and is prevalent in women rather than in men. As the diagnosis is generally delayed, owing to misleading symptoms and diagnosis, gallstone ileus has a high morbidity and mortality rate. Once the condition is diagnosed, the gallstone obstruction in the ileus is resolved through surgery. While there is no uniform procedure to remove gallstones, several treatment options are available, based on the diagnosis and clinical conditions of the patient.

Symptoms

People with gallstone ileus are generally obese and feel unwell. The initial symptom is a colicky abdominal pain, followed by vomiting, which subsides as the gallstone dislodges, but recurs when larger stones lodge in the ileus. Other associated symptoms include pain in the abdominal area, a bloated abdomen, dehydration and slight abdominal tenderness.

Diagnosis

Several diagnostic measures are used independently or in combination to detect the gallstone ileus. An abdominal X-ray is a commonly-used procedure to view a partial or complete intestinal obstruction. The X-ray also depicts the actual gallstones and air in the biliary tract. Although an X-ray detects small bowel obstruction, combining it with ultrasound and computed tomography, can help detect biliary tract pathology for an accurate diagnosis.

Treatment Procedures

In the Journal of Medical Reports, a case series on jejunal perforation in the gallstone ileus, by Dr. Browning and colleagues reported two recognized surgical procedures. A one-stage procedure that combines enterolithotomy, cholecystectomy and fistula repair, and a two-stage procedure that involves either enterolithotomy alone or cholecystectomy. The one-stage procedure is performed on relatively stable patients, while a two-stage procedure is recommended for high-risk patients.

Enterolithotomy

In the Eastern Mediterranean Health Journal, Dr. Clavien and colleagues state that enterolithotomy is a relatively simple and commonly-used procedure that reduces operative time for high-risk patients. Enterolithotomy involves a longitudinal incision on the border of the bowel to remove the obstructing gallstone.

Cholecystectomy

Enterolithotomy is followed by cholecystectomy, which is the surgical removal of the gallbladder. Latest advances in laproscopic technology have made it possible to remove the gallbladder through a tiny incision around the navel.

Fistula Closure

Fistula closure is always performed in the second stage of the operation, in a two-stage treatment procedure. The abnormal obstruction by the gallstone causes a biliary fistula, a condition where bile leaks from the bile ducts into the surrounding areas. Therefore, a repair and closure of the fistula is performed to prevent the recurrence of a gallstone ileus.

References

• Patient UK: Gallstone Ileus
• SUNY Downstate Medical Center: Gallstone Ileus
• Unbounded Medicine: Gallstone Ileus
• Jackson Siegelbaum Gastroenterology: Laparoscopic Cholecystectomy

Resources

• "Journal of Medical Case Reports"; Jejunal perforation in gallstone ileus--a case series;
• "Eastern Mediterranean Health Journal";