Diagnosis and treatment of billiary ileus

Česká verzia

Authors: O. Vyčítal ^1,2; V. Liška ^1,2; J. Geiger ¹; V. Třeška ¹
Authors place of work: Lékařská fakulta Univerzity Karlovy a Chirurgická klinika FN v Plzni přednosta: prof. MUDr. V. Třeška, DrSc. ¹; Biomedicínské centrum Plzeň vědecký ředitel: doc. MUDr. M. Štengl, Ph. D. ²
Published in the journal: Rozhl. Chir., 2016, roč. 95, č. 2, s. 83-86.
Category: Kazuistiky

Summary

Introduction:
Biliary ileus represents only 1−4% of mechanical obstructions of the gastrointestinal tract. However, the rate of non-strangulated small bowel obstructions reaches as much as 25% in patients over 65 years of age. Usually, a pressure necrosis is created by a large gallstone that passes through the developed biliodigestive fistula, subsequently obturating the gastrointestinal tract.

Case reports:
35 patients underwent a surgical procedure at the Department of Surgery, Teaching Hospital Pilsen for biliary ileus from January 1, 2000 to January 31, 2015. Mean age was 79 years (median 78 years; min. 58 years; max. 92 years). Aerobilia was visible in abdominal X-ray scans in 7 cases (26%) of 27 acquired images. Preoperatively, colonoscopy was done 2 times and esophagogastroduodenoscopy 9 times. Regarding surgical procedures, enterolithotomy was done in 21 cases, extraction of the gallstone from gastrotomy was done 3 times, small bowel resection 7 times, Hartmann resection 1 time, resection of ileoascendentoanastomosis 1 time, and extraction of the gallstone from duodenotomy with duodenojejunoanastomosis and cholecystectomy was done in 1 case. Ileotransversoanastomosis was performed in 1 case. Postoperative 30-day mortality was 14.3%. Postoperative morbidity according Clavien-Dindo was 22.8% for grade 1, 5.7% for grade 2, 11.5% for grade 3, and 11.5% for grade 4. A recurrence was observed in 8.8%. Primary treatment of the fistula and cholecystectomy were done in 1 case.

Conclusion:
The indication of primary biliodigestive fistula treatment always depends on the general condition of the patient and on the local finding in the gallbladder area. Residual fistula increases the risk of reccurence, but primary treatment is associated with higher mortality. It is also important to duly revise the entire bowel to avoid an early reccurence due to multiple gallstones.

Key words:
biliary ileus − diagnosis − treatment

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