Gallstone ileus: An analysis of 20 patients

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.