[Biliary ileus: diagnosis and therapy].

Background: Gallstone ileus represents 1-3% of mechanical obstructions of the bowel. The surgical treatment performed in urgency has a mortality rates of 10-13% because galistone ileus is frequent in the elderly. Some diagnostic and therapeutic problems are debated in this paper.

Methods: 9 cases of gallstone ileus were analysed retrospectively in a series of 736 mechanical obstructions of the bowel submitted to surgery since 1969. The Authors report the clinical and physical data, the laboratory data and the results of the radiological procedures performed (plain abdominal X-ray, abdominal US, CT, MNR). The patients are stratified according to ASA system and the surgical treatment. The accuracy of the diagnostic procedures and the surgical mortality and morbidity are reported.

Results: The preoperative diagnosis was correct in 5 patients. History, clinical and laboratory findings are not specific. The plain abdominal X-ray was specific in 1/9 case, Us in 4/9, CT in 2/3, MNR in 1/1. 1 patient was included in ASA 1 class, 3 in ASA 2 class, and 5 in ASA 3 class. Enterolithotomy alone was performed in 3 cases and the one stage treatment (enterolithotomy and bilio-digestive fistula repair) in 6. No patient was submitted to two stage procedure because 2 of the patients submitted to enterolithotomy alone had a neoplastic fistula and 1 had a very high operative risk. No intraoperative mortality was registered. A wound infection developed in 4 patients. None of the patients had a recurrence of gallstone ileus.

Conclusion: Evidence from this study supports one stage treatment when the diagnosis of gallstone ileus is correct because it is possible to delay the surgery and to perform a preoperative treatment to decrease the operative risk in the elderly. The correct preoperative diagnosis is often difficult but CT and MNR heve an high sensibility and specificity.