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Colonic gallstone ileus: a systematic literature review with a diagnostic-therapeutic algorithm

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Abstract

Rare complication of gallstone disease is gallstone ileus. The common location is the small intestine, followed by the stomach. The rarest location is colonic gallstone ileus (CGI). To summarize and define the most appropriate diagnostic methods and therapeutic options for CGI based on the paucity of published data. Literature searches of English-, German-, Spanish-, Italian-, Japanese-, Dutch- and Portuguese language articles included and Italian-language articles using PubMed, EMBASE, Web of Science, The Cochrane Library, and Google Scholar. Additional studies were identified from the references of retrieved studies. 113 cases of CGI were recorded with a male to female patient ratio of 1:2.9. The average patient age was 77.7 years (range 45–95 years). The usual location of stone impaction was the sigmoid colon (85.8%), followed by a descending colon (6.6%), transverse colon (4.7%), rectum (1.9%), and lastly, ascending colon (0.9%). Gallstones ranged from 2 to 10 cm. The duration of symptoms was variable (1 day to 2 months), with commonly reported abdominal distension, obstipation, and vomiting; 85.2% of patients had previous biliary symptoms. Diverticular disease was present in 81.8% of patients. During the last 23 years, CT scan was the most common imaging method (91.5%), confirming the ectopic gallstone in 86.7% of cases, pneumobilia in 65.3%, and cholecytocolonic fistula in 68%. The treatment option included laparotomy with cololithotomy and primary closure (24.7%), laparotomy and cololithotomy with diverting stoma (14.2%), colonic resection with anastomosis (7.9%), colonic resection with a colostomy (12.4%), laparoscopy with cololithotomy with primary closure (2.6%), laparoscopy with cololithotomy with a colostomy (0.9%), colostomy without gallstone extraction (5.3%), endoscopic mechanical lithotripsy (success rate 41.1%), extracorporeal shock wave lithotripsy (1.8%). The cholecystectomy rate was 46.7%; during the initial procedure 25%, and as a separate procedure, 21.7%; 53.3% of patients had no cholecystectomy. The survival rate was 87%. CGI is the rarest presentation of gallstone ileus, mainly in women over 70 years of age, with gallstones over 2 cm, and predominantly in the sigmoid colon. Abdominal CT is diagnostic. Nonoperative treatment, particularly in subacute presentations, should be the first-line treatment. Laparotomy with cololithotomy or colonic resection is a standard procedure with favorable outcomes. There are no robust data on whether primary or delayed cholecystectomy is mandatory as a part of CGI management.

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Acknowledgements

The authors would like to thank Livia Puljak for improving the methodology of a systematic review. The authors would also like to thank Anis Dizdarević for comments, suggestions, and English language proofing. All research data are available as a supplement.

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Authors and Affiliations

  1. School of Medicine, University of Zagreb, Zagreb, Croatia

    Goran Augustin & Kristian Kunjko

  2. Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia

    Goran Augustin, Tomislav Bruketa, Kristian Kunjko & Ivan Romić

  3. Department of Gynecology and Obstetrics, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia

    Mislav Mikuš & Adam Vrbanić

  4. Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, University of Pittsburgh Medical Center, Palermo, Italy

    Alessandro Tropea

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GA: data collection, data analysis, and manuscript writing. KK, AT, and TB: data collection and data analysis. TB: manuscript writing, supervision. IR, MM, and AV: data analysis and manuscript writing.

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Correspondence to Mislav Mikuš.

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Augustin, G., Bruketa, T., Kunjko, K. et al. Colonic gallstone ileus: a systematic literature review with a diagnostic-therapeutic algorithm. Updates Surg 75, 1071–1082 (2023). https://doi.org/10.1007/s13304-023-01537-0

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