New in the problem gallstone bowel obstruction

Aim. To identify the frequency of gallstone ileus based on the surgical experience of the Kiev region in patients with acute calculous cholecystitis and acute intestinal obstruction. To evaluate the capabilities of the gallstone ileus diagnosis algorithm for correct topical diagnosis before surgery.

Materials and methods. For 2004–2018, 13713 patients with acute cholecystitis and 3609 patients with acute intestinal obstruction were hospitalized. In 0.64% of cases, gallstone ileus was diagnosed in patients with acute calculous cholecystitis, in 0.41% in choledocholithiasis, and in 2.4% in its complex forms. In 0.73% gallstone ileus was detected during operations for acute intestinal obstruction and in 1.12% for its obstructive form.

Results. A total of 25 patients with gallstone intestinal obstruction underwent surgery. In the topical diagnosis of gallstone intestinal obstruction, X-ray contrast methods dominate. During surgical procedure, only with pyloroduodenal variants of obstruction, cholecystectomy is performed simultaneously with the elimination of obstruction. In other situations, cholecystectomy is performed after 3–8 months. Of the 25 patients, 4 patients died due to ascending cholangitis, peritonitis due to bile leakage, and severe co-morbidities.

Conclusion. The use of the algorithm of advanced diagnostic methods allows you to receive a diagnosis in most patients. The most valuable in topical diagnostics are contrast methods. New in gallstone ileus is the migration of gallstone after endoscopic papillosphincterotomy with mechanical lithotripsy for choledocholithiasis, especially with its complex forms. In our opinion, all types of gallstone ileus can be combined into Bartolin-Bouveret syndrome, which first described this variant of mechanical intestinal obstruction.

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