Home > Journals > Chirurgia > Past Issues > Chirurgia 2020 April;33(2) > Chirurgia 2020 April;33(2):102-6

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as

 

CASE REPORT   

Chirurgia 2020 April;33(2):102-6

DOI: 10.23736/S0394-9508.19.04966-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: Italian

Biliodigestive fistula and gall stone ileus: a case report

Virna ROBUSTELLI , Massimo FEDI, Sara RICCADONNA, Sandro GIANNESSI

Operative Unit of General Surgery, San Jacopo Hospital, Pistoia, Italy



Gall stone ileus is a rare cause of intestinal obstruction and is defined as the mechanical obstruction of the gastrointestinal tract caused by the entry in it of one or more gallstones due to the presence of a bilio-digestive fistula. Surgical treatment remains the main therapeutic approach although it remains controversial for many authors the choice between the various surgical options: the only enterolithotomy, which consists in performing a longitudinal intestinal incision with extraction of the gallstone and transversal suture; the “one-stage” procedure which consists in associating with the enterolithotomy the treatment of the bilio-digestive fistula and the cholecystectomy; the “two-stage” procedure consisting of an initial enterolithotomy operation followed later by the treatment of the bilio-digestive fistula and cholecystectomy. We describe the clinical case of an 88-year-old woman who presents to the ER for vomiting and fever associated with abdominal pain and bowel closed to gas and feces. The CT scan of the abdomen highlights the presence of a cholecystico-duodenal fistula and a voluminous gallstone impacted in a jejunal-ileal loop. The patient underwent to enterolithotomy, without proceeding neither to cholecystectomy nor to treatment of bilio-digestive fistula. To conclude, data in the literature are limited and there are no randomized clinical trials that support optimal therapy for this rare condition. Among the different alternatives described in the bibliography, we believe that only enterolithotomy is the procedure of choice in the emergent treatment of intestinal obstruction from gallstone ileus.


KEY WORDS: Gallstones; Fistula; Intestinal obstruction

top of page