Gallstone ileus

Abstract

OBJECTIVE: To determine the frequency of gallstone ileus as a cholelithiasis complication and likely cause of intestinal obstruction, as well as the factors that can influence morbidity and mortality of these patients in our hospital. MATERIAL AND METHODS: The files of patients undergoing cholecystectomy, as well as of those patients surgically treated for intestinal obstruction between January 2001 and December 2003, were reviewed. We analyzed the files of patients with gallstone ileus for the following characteristics: age, sex, time of evolution, signs and symptoms, diagnosis, APACHE II, concomitant diseases, mode of treatment, obstruction/fistula site and morbidity and mortality. RESULTS: A total of 1054 patients for cholelithiasis and 189 for intestinal obstruction were treated surgically. Of these, there were seven cases of gallstone ileus: six females (85.7%) and one male (14.3%). Average age was 62.85 years (range: 39 to 89 years). Average time of evolution was 4.85 days until the surgical intervention. Preoperative diagnosis ws carried out in five of seven cases (71.42%). APACHE II for severity was present in all patients >60 years old; 71.42% of the cases presented some associated chronic illness. Surgical procedure was enterolithotomy without dismantlement of the fistula in five of seven cases and in two of seven cases surgery was carried out in a single stage. Obstruction occurred in ileum (four of seven cases), jejunum (two of seven cases), and one in the duodenum; the fistula occurred in duodenum in five cases and two cases in the stomach. Morbidity and general mortality were, respectively, 28.57% and 14.28%. CONCLUSIONS: We found a frequency of 0.66% of gallstone ileus as a complication of cholelithiasis (7/1054 cases) and 3.70% as a case of intestinal obstruction (7/189 cases), increasing to 12% in patients >60 years. The factors that elevated the morbidity and mortality were a delay in seeking medical care, patients > 60 years, associated chronic illnesses and an APACHE II for severity.