Gallstone ileus: An analysis of 20 patients

Abstract

Abstract An analysis of 20 patients with gallstone ileus treated at the University Hospital in Linköping during a 10‐year period is presented. The patients had a median age of 75 years and 70% were women. The symptomatology was usually vague and consisted of diffuse abdominal pain, often accompanied by vomiting. The delay before admission to the hospital averaged 4 days. Radiography with both plain abdominal x‐rays and a barium meal showed mechanical intestinal obstruction in all but 1 patient and gallstone ileus was diagnosed before laparotomy in 60% of patients. Enterolithotomy was performed in all patients but there was no surgery on the gallbladder and/or the fistula. The frequency of postoperative wound infection was 25%. There was only 1 death, a mortality rate of 5%. It is our opinion that the low mortality was due to early diagnoses, careful preoperative preparation, an operative procedure aiming only at relief of the obstruction, and improved anesthesia and prophylactive short‐term antibiotics. The only indication for an elective cholecystectomy is persistent symptoms of gallbladder disease.