Published online Jan 27, 2016. doi: 10.4240/wjgs.v8.i1.65
Peer-review started: July 9, 2015
First decision: September 22, 2015
Revised: November 11, 2015
Accepted: December 7, 2015
Article in press: December 8, 2015
Published online: January 27, 2016
Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract. Less than 1% of cases of intestinal obstruction are derived from this etiology. The symptoms and signs of gallstone ileus are mostly nonspecific. This entity has been observed with a higher frequency among the elderly, the majority of which have concomitant medical illness. Cardiovascular, pulmonary, and metabolic diseases should be considered as they may affect the prognosis. Surgical relief of gastrointestinal obstruction remains the mainstay of operative treatment. The current surgical procedures are: (1) simple enterolithotomy; (2) enterolithotomy, cholecystectomy and fistula closure (one-stage procedure); and (3) enterolithotomy with cholecystectomy performed later (two-stage procedure). Bowel resection is necessary in certain cases after enterolithotomy is performed. Large prospective laparoscopic and endoscopic trials are expected.
Core tip: A review of the symptoms and signs of gallstone ileus is presented. The findings, advantages and limitations of the different diagnostic modalities such as plain abdominal radiographs, upper gastrointestinal series, ultrasound, computed tomography, magnetic resonance and endoscopy are reviewed. The different surgical options are discussed. Laparoscopic and endoscopic procedures are widely reviewed. Current data on morbidity and mortality are included.