Gall-stone obstruction.

Br J Surg

Published: August 1966

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http://dx.doi.org/10.1002/bjs.1800530805DOI Listing

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Laparoscopic surgery for gallstone ileus.

BMJ Case Rep

January 2025

Department of General Surgery, Ealing Hospital, London North West University Healthcare NHS Trust, London, UK.

We present a case of a woman in her 70s who arrived in the emergency department with signs of small-bowel obstruction. CT scanning revealed acute cholecystitis with a cholecystoduodenal fistula, pneumobilia and small-bowel obstruction possibly secondary to gallstone ileus although no radio-opaque gallstones were seen. The patient underwent an emergency operation and intra-operative findings revealed mechanical small-bowel obstruction of the proximal jejunum where a 4×2 x 3 cm gallstone was impacted.

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Gallstone ileus, a rare cause of mechanical bowel obstruction, occurs due to the formation of a cholecystenteric fistula allowing gallstones to migrate into the gastrointestinal tract. The condition occurs mostly in elderly patients, particularly women, and carries a significant mortality risk due to delayed diagnosis. This case report discusses a 77-year-old female patient with a history of chronic medical conditions, who self-presented with periumbilical pain, nausea, and reduced bowel movements.

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Background Cholangitis, or bile duct infection, can present in two primary forms, namely, acute ascending cholangitis (the milder form) and acute fulminant cholangitis (the more severe variety). In all types of cholangitis, bile duct obstruction occurs, with choledocholithiasis (the presence of gallstones in the bile duct) being the leading cause of this blockage. is the most commonly isolated pathogen in these infections.

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Gallstone ileus is the mechanical obstruction of the bowel due to gallstone impaction. It forms when a fistula is created between the gallbladder and the gastrointestinal tract, which can result in small bowel obstruction. Its surgical management ranges from enterolithotomy, cholecystectomy, and fistula closure performed together (one-stage) or performed separately (two-stage), while some patients undergo simple enterolithotomy.

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Acute cholecystitis, often caused by gallstones obstructing the cystic duct, is a potentially life-threatening condition that requires timely intervention. High-risk patients, particularly those with significant comorbidities, may not be suitable candidates for laparoscopic cholecystectomy, necessitating alternative drainage techniques such as percutaneous cholecystostomy (PC) and endoscopic gallbladder drainage (EGD). This systematic review aims to compare the efficacy, safety, and outcomes of PC and EGD in managing acute cholecystitis in high-risk surgical patients.

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