Laparoscopic management of gallstone ileus

Abdominal CT scan with contrast is therefore the preferred definitive study shown to be accurate in diagnosing gallstone ileus and often shows pneumobilia, small bowel obstruction, and intestinal intraluminal gallstones.3 This report and others confirm that laparoscopy is also effective in both diagnosis and treatment of gallstone ileus.4 Although laparoscopy allows the entire small bowel to be examined using the two-handed technique, caution is required in handling the obstructed bowel, which is often edematous and friable and therefore prone to inadvertent enterotomy. At the present time, there are very few cases reported in the literature with these alternative procedures as a result of the rarity of this entity; however, the mortality reported has decreased from 40 per cent in 1960 to 15 to 18 percent in the 1990s.1 Reisner and Cohen reported in 1994 a mortality rate as low as 11.7 per cent for patients having enterolithotomy alone versus 16.9 per cent for patients undergoing enterolithotomy plus definitive cholecystectomy and closure of fistula in one stage.1 Currently, there is ongoing controversy regarding the optimal management of the cholecystenteric fistula with proponents of a singlestage procedure arguing cholecystectomy and fistula closure would potentially prevent attacks of cholecystitis, cholangitis, and recurrent gallstone ileus.