Gallstone ileus (GI) is an uncommon cause of bowel obstruction that is associated with high rates of morbidity and mortality. Management of GI remains controversial due to concerns about timing and prioritization of management of coexisting bowel obstruction and cholecystoenteric fistula. This retrospective study reports five cases which were treated in the surgery department for GI in a hospital in Rabat, and a literature review. Of the five patients identified, the average age was 62 years. Length of obstruction prior to operation was 2.8 days. Intraoperatively, the size of the gallstones ranged from 2.5 to 3.8 cm in diameter. Eighty percent patients underwent a simple enterolithotomy and only one had a laparoscopically assisted surgery. Mortality in this series was 20%, and the single patient death was attributed to comorbid conditions. In this series of five patients, GI affected the more elderly population (average age: 62 years) and the diagnosis was established 2 to 3 days after the onset of symptoms. Given the high rates of morbidity and mortality associated with the management of GI, a simple enterolithotomy remains the best solution and one stage procedure should be reserved mainly for younger patients.
Key words: Gallstone ileus, biliary enteric fistula, enterolithotomy, one stage procedure, laparoscopic assisted surgery
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