One-step approach by enterolithotomy as surgical treatment of biliary ileus associated with bridle: case report and literature review

Abstract

Gallstone ileus is a rare cause of intestinal obstruction, more common in adults and in the context of late complications due to gallbladder stones. The pathophysiology describes long-term inflammatory processes of the gallbladder, with biliodigestive fistula development and passage of the gallstone into the intestine, impacting the terminal ileum in most cases. It manifests with data of intestinal obstruction in patients with a chronic history of gallbladder lithiasis. The ideal imaging study is a computed tomography (CT) scan of the abdomen to identify pneumobilia, intestinal obstruction and the lithiasis impacting on the bowel. The surgical approach depends on the context of each patient through laparoscopy or laparotomy in order to perform enterotomy and extraction of the stone or by performing also the management of the fistula and cholecystectomy at the same surgical time. Management must be individualized for each patient. We present the case of a patient in her tenth decade of life with a history of recurrent biliary colic without management, who was admitted to the general surgery department with data of probable intestinal occlusion. Imaging studies were performed, with radiographic evidence of distension of the small bowel loops and tomography with findings suggestive of biliary ileus. Due to the clinical context and comorbidities of the patient, laparotomy with enterotomy and extraction of the stone was performed.