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      Gallstone Ileus with COVID‐19 Infection: An Unintended Sequela of Non‐Operative Management of Acute Cholecystitis During the COVID‐19 Pandemic

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          Abstract

          Appropriate risk stratification and careful follow‐up are mandated in elderly patients with comorbidities. Herein, we report a case presenting 5 months after the nonoperative management of acute cholecystitis during the height of the COVID‐19 pandemic.

          Abstract

          Appropriate risk stratification and careful follow‐up are mandated in elderly patients with comorbidities. Herein, we report a case presenting 5 months after the nonoperative management of acute cholecystitis during the height of the COVID‐19 pandemic.

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          Gallstone ileus: a review of 1001 reported cases.

          M Reisner, David J. Cohen (1994)
          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 proper extent of surgery continues to be actively debated. Proponents of minimal surgery feel that relief of the obstruction is all that is required. Others argue that the gallbladder and biliary-enteric fistula must be removed to prevent future recurrence (a one-stage procedure). The one-stage procedure carries an associated mortality of 16.9 per cent, compared to 11.7 per cent for simple enterolithotomy. Morbidity after enterolithotomy is low. The recurrence rate of gallstone ileus was less than 5 per cent, and only 10 per cent of patients required reoperation for continued symptoms related to the biliary tract. Simple enterolithotomy is both safe and effective in dealing with a patient with gallstone ileus.
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            Gallstone ileus

            A. Rohner, S. Burgan, J Richon … (1990)
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              Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus.

              A. Saif, Leen Kawas (2002)
              Gallstone is a common disease with a 10% prevalence in the United States and Western Europe. However, it is only symptomatic in 20-30% of patients, with biliary pain "colic" being the most common symptom. Complications of asymptomatic gallstone disease are generally rare, with an incidence of <1 %/yr. The most common complications of gallstone disease are acute cholecystitis, acute pancreatitis, ascending cholangitis, and gangrenous gallbladder. Less frequent complications include Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Mirizzi syndrome and cholecystocholedochal fistula are two manifestations of the same process that starts with impaction of a gallstone in the gallbladder neck that results in obstruction of the bile duct, causing jaundice. The gallstone may erode into the bile duct, causing cholecystocholedochal fistula. Gallstone ileus refers to small bowel obstruction resulting from the impaction of one or more gallstones after they have migrated through a cholecystoenteric fistula. An accurate diagnosis is essential to the management and prevention of further complications. A variety of imaging and endoscopic modalities are used to make the diagnosis once the condition is suspected clinically. Treatment should be tailored to each individual patient. Management choices include ERCP, lithotripsy (endoscopic or extracorporeal), and surgery. Prognosis is frequently related to early recognition, management of any comorbid conditions, and careful selection of treatment modalities.
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                Author and article information

                Contributors
                Adil A. Shah: adshah@huhosp.org
                Journal
                Journal ID (nlm-ta): Clin Case Rep
                Journal ID (iso-abbrev): Clin Case Rep
                Journal ID (doi): 10.1002/(ISSN)2050-0904
                Journal ID (publisher-id): CCR3
                Title: Clinical Case Reports
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2050-0904
                Publication date (Electronic): 19 July 2021
                Publication date Collection: July 2021
                Volume: 9
                Issue: 7 ( doiID: 10.1002/ccr3.v9.7 )
                Electronic Location Identifier: e04275
                Affiliations
                [ 1 ] Department of Surgery Howard University Hospital and College of Medicine Washington DC USA
                [ 2 ] Department of Surgery George Washington University School of Medicine Washington DC USA
                Author notes
                [*] [* ] Correspondence

                Adil A. Shah, Department of Surgery, Howard University Hospital and College of Medicine, 2041 Georgia Avenue,Washington, DC, USA.

                Email: adshah@ 123456huhosp.org

                Author information
                https://orcid.org/0000-0002-9095-1840
                Article
                Publisher ID: CCR34275
                DOI: 10.1002/ccr3.4275
                PMC ID: 8287320
                PubMed ID: 34295474
                SO-VID: f811931d-3691-43d1-b8fb-a2bcda41ac8b
                Copyright © © 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date revision received : 29 March 2021
                Date received : 16 February 2021
                Date accepted : 08 April 2021
                Page count
                Figures: 5, Tables: 0, Pages: 0, Words: 2514
                Categories
                Subject: Case Report
                Subject: Case Reports
                Custom metadata
                source-schema-version-number 2.0
                cover-date July 2021
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.4 mode:remove_FC converted:19.07.2021

                Keywords: acute care surgery,complicated cholecystitis,gallstone ileus,small bowel obstruction
                Data availability:
                Keywords: acute care surgery, complicated cholecystitis, gallstone ileus, small bowel obstruction

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