engleski

The comparison of surgical treatments of gall stone ileus: a preliminary report

BACKGROUND: Gall stone ileus is an uncommon cause of small bowel obstruction, accounting for only 1-4% of all intestinal obstructions. In the group of patients over 65 years of age, gall stones cause about 25% of all non-strangulated obstructions of the small bowel. Gall stone ileus is burdened with high mortality rate ranging from 12-18% and most patients are of advaced age, with many other concomitant diseases that may increase the operative risk. AIM: The purpose of this study was to compare the two investigated surgical procedures: treatment of intestinal obstruction alone or combined with urgent cholecystectomy and fistula repair. PATIENTS AND METHODS: Analysis of 30 patients operated for gallstone ileus at the Clinical Hospital &laquo ; Sestre milosrdnice&raquo ; between 1985 and 2001 is presented. Patients were treated either for ileus alone (group I, 11 patients) or as one stage procedure with urgent fistula closure (group 2, 19 patients). RESULTS: Operating time was significanly longer for one stage procedure. Complications occurred in 3 of 11 patients (27.3%) from group I and in 11 of 18 patients (61.1%) fom group 2. One patient died in group 1 and two died in group 2. Urgent fistula repair was significanly associated with the occurrence of complications (OR 12.1, 95% CI 1.2-121.5). CONCLUSION: We believe that simple enterotomy should be the procedure of choice for patients with gall stone ileus. One stage procedure including urgent fistula repair should be reserved only for highly selected patients in good general condition.

gall stone ileus; cholecystectomy; fistula repair

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