SEVEN CASES OF GALLSTONE ILEUS

Abstract

Ileus caused by impaction of gallstones is a rare disease. This paper describes our experience with seven cases of gallstone ileus from 1965 to 1992. A preponderance of gallstone ileus in the femal and aged patients is suggested. A suspicious history of biliary tract disease or diabetes was frequently noted. The site of obstruction included the smallintestine in all cases. The route of gallstone migration was a cholecystoduodenal fistula in 5 cases and unknown in 2. Resected stones were mixed stones in 3 cases and calcium bilirubinate stones in 4. Two cases were correctly diagnosed preoperatively, and in one of them the diagnosis was made by CT which demonstrated an obstruction of the small intestine and pneumoiblia. The necessity of CT should be emphasized in the diagnosis of gallstone ileus. Surgical procedures included enterolithotomy for 6 cases and cholecystectomy and repair of the fistula with enterotomy for only one. One of 6 cases without cholecystectomy had a gallblandder carcinoma 9 years after enteroli-thotomy. It is important that radical operation on an one-step approach is comploved as far as possible.