Post-cholecystectomy Gallstone Ileus: A Narrative Review

Abstract

Gallstone ileus (GSI) is a rare cause of mechanical obstruction, caused by a gallstone that enters the gastrointestinal tract typically via a cholecystoduodenal fistula. Post-cholecystectomy gallstone ileus (PCGSI) is a specific subset occurring in patients who have previously undergone cholecystectomy. This paper aims to explore the characteristics and proposed aetiologies of PCGSI through a comprehensive narrative review of 26 case reports published between 2000 and 2024. The mechanisms leading to PCGSI are categorized into several aetiologies: bilioenteric fistulas, transpapillary gallstones, lost stones during cholecystectomy, and reconstructive surgery-associated gallstones. The findings underscore that while PCGSI shares similarities with GSI, it can present unique challenges due to its varied aetiologies, leading to misdiagnosis and consequent delays in treatment. The study emphasizes the importance of accurate imaging techniques, particularly CT scans, for effective diagnosis and highlights the need for awareness among clinicians regarding this rare condition's presentation and underlying mechanisms.