Atypical presentation of biliary ileus: individualized surgical approach. Case report
DOI:
https://doi.org/10.29166/rfcmq.v50i2.6962Keywords:
Biliary Ileus, Cholecystitis, Laparoscopy, EnterolithotomyAbstract
Introduction: Biliary ileus, representing less than 0.5% of intestinal obstructions, arises as an uncommon complication of cholelithiasis. This condition originates from biliary-enteric fistulas, mainly cholecystoduodenal, and its diagnosis often poses challenges due to nonspecific clinical manifestations.
Objective: To describe a case of biliary ileus with an atypical presentation and analyze the individualized surgical approach employed, highlighting the criteria used for decision-making and its impact on managing intestinal obstruction.
Case Presentation: The patient presented with an insidious clinical course characterized by abdominal pain, vomiting, and weight loss, leading to an extensive exploratory laparoscopy that resulted in an enterolithotomy to address the obstruction.
Discussion: The Mordor triad, along with imaging studies such as computed tomography, aids in the diagnosis, although it is often confirmed during surgery. The standard surgical management, whether laparotomy or laparoscopy, is adapted according to the patient's risk, with either one- or two-phase approaches.
Conclusion: Biliary ileus, though rare, requires prompt recognition and personalized surgical intervention. The absence of a uniform approach underscores the need for individualized decisions based on surgical risk, recurrence, and associated mortality.
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Halabi WJ, Kang CY, Ketana N, Lafaro KJ, Nguyen VQ, Stamos MJ, et al. Surgery for gallstone ileus: a nationwide comparison of trends and outcomes. Ann Surg [Internet]. 2014 Feb [cited 2024 Jun 27];259(2):329–35. Available from: https://pubmed.ncbi.nlm.nih.gov/23295322/
Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL. Gallstone ileus, clinical presentation, diagnostic and treatment approach. World J Gastrointest Surg [Internet]. 2016 [cited 2024 Jun 27];8(1):65. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4724589/
Gupta AK, Vazquez OA, Yeguez JF, Brenner B. Laparoscopic Approach for Gallstone Ileus in Geriatric Patients. Cureus [Internet]. 2020 Jun 15 [cited 2025 Jan 07];12(6). Available from: https://pubmed.ncbi.nlm.nih.gov/32685311/
Aguilar-Espinosa F, Maza-Sánchez R, Vargas-Solís F, Guerrero-Martínez GA, Medina-Reyes JL, Flores-Quiroz PI. Cholecystoduodenal fistula, an infrequent complication of cholelithiasis: Our experience in its surgical management. Rev Gastroenterol Mex [Internet]. 2017 Oct 1 [cited 2024 Jun 27];82(4):287–95. Available from: https://www.revistagastroenterologiamexico.org//en-cholecystoduodenal-fistula-an-infrequent-complication-articulo-S2255534X17300762
Reyes-Morales JM, Hernández-García LK. Íleo biliar: un reto diagnóstico y terapéutico. Presentación de un caso clínico. Rev Med Inst Mex Seguro Soc [Internet]. 2023 [cited 2024 Jun 27];61(1):106. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10395987/
Chang L, Chang M, Chang HM, Chang AI, Chang F. Clinical and radiological diagnosis of gallstone ileus: a mini review. Emerg Radiol [Internet]. 2018 Apr 1 [cited 2024 Jun 27];25(2):189–96. Available from:
https://link.springer.com/article/10.1007/s10140-017-1568-5
Gaikwad V, Subramanian M, Lim KT, Peh WCG. Clinics in diagnostic imaging (216). Singapore Med J [Internet]. 2023 May 1 [cited 2024 Jun 27];64(5):330–4. Available from: https://journals.lww.com/smj/fulltext/2023/05000/clinics_in_diagnostic_imaging__216_.8.aspx
Mallipeddi MK, Pappas TN, Shapiro ML, Scarborough JE. Gallstone ileus: revisiting surgical outcomes using National Surgical Quality Improvement Program data. J Surg Res [Internet]. 2013 [cited 2024 Jun 27];184(1):84–8. Available from: https://pubmed.ncbi.nlm.nih.gov/23764312/
Macías-Segura SA, Castro-Rodríguez JM, Quintero-Pérez YY, Granados-Martínez CA. Íleo biliar: descripción de dos casos. Rev Colomb Cir [Internet]. 2023 Jun 22 [cited 2025 Feb 6];38(4):753–8. Available from: https://www.revistacirugia.org/index.php/cirugia/article/view/2260
Bueno-Cañones AD, Bailón-Cuadrado M, Asensio-Díaz E, Pacheco-Sánchez D, Bueno-Cañones AD, Bailón-Cuadrado M, et al. Íleo biliar. Reporte de casos. Rev Cir (Mex) [Internet]. 2020 [cited 2025 Feb 6];72(5):468–71. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S2452-45492020000500468&lng=es&nrm=iso&tlng=es
Ploneda-Valencia CF, Gallo-Morales M, Rinchon C, Navarro-Muñiz E, Bautista-López CA, de la Cerda-Trujillo LF, et al. El íleo biliar: una revisión de la literatura médica. Rev Gastroenterol Mex [Internet]. 2017 Jul 1 [cited 2024 Jun 27];82(3):248–54. Available from: https://www.revistagastroenterologiamexico.org//es-el-ileo-biliar-una-revision-articulo-S0375090617300137
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