The treatment of gall stone ileus is –
Correct Answer: Removal of obstruction
Description: Answer 'b' i.e. Removal of obstruction The treatment priroity should focus on relief of obstruction and not on gall bladder and its fistulous communication. So the procedure of choice is - Laprotomy with stone extraction. The gallbladder disease can be dealt on later, which includes cholecystectomy and closure of the fistulous tract. [Note that Sabiston (18/e p1572), differs with the above management. It writes that - "Takedown of the biliary-enteric fistula and cholecystectomy during the same procedure is warranted because recurrent cholecystitis and cholangitis are common. However, in patients with a significant inflammatory process in the right upper quadrant or who are unstable to withstand a prolonged operative procedure, the fistula can be addressed at a second laparotomy." However the above management is suppoed by Bailey, Harrison, Maingot's and CSDTI
Category:
Surgery
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