[Biliary ileus. Review of the literature and report of 22 further cases].

A critical review of the world literature of the main authors in the past twenty years (871 cases) and the personal series (1975-1987: 22 cases) shows that biliary ileus is a rare, serious pathology with an emergency surgical indication. The numerical data collected confirm the need for a conservative surgical attitude, limited to the removal of the obstructing cause. Some authors have maintained that it is possible to treat the occlusion and the bilio-digestive fistula and carry out the cholecystectomy contemporaneously. Personally it is considered that the latter possibility can be confined to carefully selected patients who are not too elderly, do not present associated pathologies and for whom the diagnostic opinion is one of preoperative biliary ileus. Cholecystectomy is therefore programmed and this is followed at a later stage by repair of the biliary fistula, the occlusive pathology being corrected immediately so as to eliminate as far as possible the immediate risks of prolonged emergency surgery on the bile ways and digestive tract at the same time.