Gallstone Ileus in the Elderly: Still a Challenge, Report of a Case with Review of the Current Literature

 Abstract

Introduction: Gallstone ileus is described as an intestinal obstruction caused by luminal gallstone impaction. It is a mainly geriatric disease with a prevalence of over 25 % in the elderly population. Morbidity and mortality rates are high which are caused due to the delayed presentation, diagnosis and treatment in comorbid patients. Interestingly, since the past century, the optimal surgical procedure in this type of mechanical ileus is still highly controversial and challenging.

Presentation of case: In the current paper we demonstrate our experience with a patient treated at our institution due to gallstone ileus. During surgical exploration the impacted stone in the terminal ileum was removed without preforming a cholecystectomy. This decision was made because of the unstable and septic status of the patient necessitating quick relief of the obstruction and no signs of ongoing severe peritonitis and acute Cholecystitis. She had an uneventful postoperative course.

Discussion & conclusion: While enterolithotomy is performed most commonly because of the low incidence of complications, the risk of developing recurrent biliary symptoms has led to a more aggressive approach with concomitant fistula repair and cholecystectomy.

Keywords: Gallstone ileus, elderly patients, surgical therapy, decision-making

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