Abstract

PEREZ-BALTODANO, Allan; BERMUDEZ-COTO, Marcela; CENTENO-RODRIGUEZ, Madelein  and  VARGAS-ALPIZAR, William. Íleo biliar. Acta méd. costarric [online]. 2005, vol.47, n.1, pp.53-56. ISSN 0001-6002.

Gallstone ileus is a clinical entity of difficult diagnosis; it is the result of an anomalous communication between the biliary tree and the gastrointestinal tract, with the eventual evacuation of the gallstone which becomes impacted in the distal tract where it causes intestinal obstruction. We report the case of a 47-year-old male, without relevant past medical history, who arrived to the emergency room with epigastric and right upper quadrant pain, fever and vomiting. The abdominal ultrasound showed acute cholecystitis. A conventional abdominal film showed air- filled small bowel loops and a fixed loop in the right upper quadrant. An exploratory laparotomy revealed a cholecystogastric fistula and intestinal obstruction secondary to an impacted gallstone in the mid - ileum. Cholecystectomy, enterolithotomy, enterorraphy, and fistula repair were performed in one stage. We reviewed the literature regarding gallstone ileus management to examine the controversy that still exists when dealing with surgical indications in this entity.

Keywords : Íleo biliar; obstrucción intestinal; fístula colecistogástrica; gallstone ileus; intestinal obstruction; cholecystogastric fistula.