Gallstone ileus:Diagnostic and therapeutic dilemma

Introduction: Gallstone ileus is a rare complication of cholelithiasis but an established cause of mechanical bowel obstruction in the elderly. Concomitant co–morbidities are frequent in older patients and responsible for the high mortality rate. The aim of the present study was to evaluate and discuss different surgical approaches and to analyze the clinical outcome. Case Series: Over a period of two years, three patients with a mean age of 78 years presented with complains of abdominal pain, nausea and vomiting of approximately two days duration. Diagnosis of gallstone ileus was made on computed tomography (CT) scan, which showed cholecystoenteric fistula and small bowel obstruction at the point of impaction of the gallstone. All the patients underwent enterolithotomy without a follow up biliary tract surgery. The postoperative course was uneventful in all the cases. Conclusion: Gallstone ileus is a rare condition, occurring in elderly with multiple co­morbidities. The appropriate surgical intervention remains controversial. Enterolithotomy alone was performed in all the patients with favorable outcome.