GALLSTONE ILEUS - A REVIEW OF 1001 REPORTED CASES

Although rare in the general population, gallstone ileus accounts for 25 per cent of nonstrangulated small bowel obstructions in those over the age of 65. While mortality has declined over the years, it remains high at 15-18 per cent. This is largely due to the patient population , with comorbid medical conditions contributing to mortality. The prop er extent of surgery continues to be actively debated. Proponents of m inimal surgery feel that relief of the obstruction is all that is requ ired. Others argue that the gallbladder and biliary-enteric fistula mu st be removed to prevent future recurrence (a one-stage procedure). Th e one-stage procedure carries an associated mortality of 16.9 per cent , compared to 11.7 per cent for simple enterolithotomy. Morbidity afte r enterolithotomy is low. The recurrence rate of gallstone ileus was l ess than 5 per cent, and only 10 per cent of patients required reopera tion for continued symptoms related to the biliary tract. Simple enter olithotomy is both safe and effective in dealing with a patient with g allstone ileus.