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Cholelithiasis, Rare Complications

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    Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Please consult the latest official manual style if you have any questions regarding the format accuracy.

    AMA Citation
    Cholelithiasis, Rare Complications. In: Doherty GM. Doherty G.M.(Ed.),Ed. Gerard M. Doherty.eds. Quick Answers Surgery. McGraw-Hill; Accessed July 04, 2020. https://accesssurgery.mhmedical.com/content.aspx?bookid=853&sectionid=49662043
    APA Citation
    Cholelithiasis, rare complications. Doherty GM. Doherty G.M.(Ed.),Ed. Gerard M. Doherty. (2010). Quick Answers Surgery. McGraw-Hill. https://accesssurgery.mhmedical.com/content.aspx?bookid=853&sectionid=49662043
    MLA Citation
    "Cholelithiasis, Rare Complications." Quick Answers Surgery Doherty GM. Doherty G.M.(Ed.),Ed. Gerard M. Doherty. McGraw-Hill, 2010, https://accesssurgery.mhmedical.com/content.aspx?bookid=853&sectionid=49662043.

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Gallstone Ileus

  • • Small bowel obstruction secondary to 1 or more large gallstones entering via cholecystoduodenal fistula

Mirizzi Syndrome

  • • Biliary stricture secondary to direct compression by chronically impacted cystic duct gallstone or chronic inflammation secondary to chronically inflamed gallbladder

Epidemiology

  • • Both gallstone ileus and Mirizzi syndrome are rare complications mainly affecting patients older than 60 years

Symptoms and Signs

Gallstone Ileus

  • • Signs and symptoms of small bowel obstruction and possible antecedent history of biliary colic

Mirizzi Syndrome

  • • Chronic or history of right upper quadrant pain along with jaundice

Laboratory Findings

Gallstone Ileus

  • • Hypokalemia

    • Prerenal azotemia

    • Hypernatremia

    • Leukocytosis

Mirizzi Syndrome

  • • Hyperbilirubinemia

    • Elevated alkaline phosphatase

Imaging Findings

Gallstone Ileus

  • • Abdominal x-ray

    • -Air-fluid levels

      -Dilated loops of small bowel

      -Possible pneumobilia

    • US

    • -Cholelithiasis and pneumobilia

    • Hypaque swallow

    • -Fistula between duodenum and gallbladder

Mirizzi Syndrome

  • • US

    • -Biliary dilatation (> 6 mm)

      -Cholelithiasis

      -Possible thickened wall of gallbladder

    • ERCP or percutaneous transhepatic cholangiogram (PTC)

    • -Stricture of common bile duct

Gallstone Ileus

  • • Overall clinical status of patient

Mirizzi Syndrome

  • • Evaluate for malignant causes of stricture

Gallstone Ileus

  • • History and physical exam

    • CBC

    • Electrolytes

    • Blood urea nitrogen, creatinine

    • Plain abdominal x-ray

    • Right upper quadrant US

    • Small bowel contrast study if partial small bowel obstruction

Mirizzi Syndrome

  • • History and physical exam

    • CBC

    • Liver function tests

    • Right upper quadrant US

Surgery

Gallstone Ileus

  • • Removal of retained small bowel gallstone(s) via enterostomy or partial resection if bowel damaged

    • Cholecystectomy and resection of fistula and duodenal closure at same operation or as staged procedure

Mirizzi Syndrome

  • • Cholecystectomy and resection and/or bypass of stricture via hepaticojejunostomy

Contraindications

  • • Clinical status of patient during laparotomy for gallstone ileus

Complications

Gallstone Ileus

  • • Missed enteral gallstone and recurrent obstruction

    • Duodenal leak

    • Bile duct injury or leak

Mirizzi Syndrome

  • • Anastomotic leak or stricture

    • Cholangitis

References

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Glasgow RE et al: The spectrum and cost of complicated gallstone disease in California. Arch Surg 2000;135:1021.  [PubMed: 10982504]
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Berber E et al: Selective use of tube cholecystostomy with interval laparoscopic cholecystectomy in acute cholecystitis. Arch Surg...

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