[Biliary ileus].

The authors report a retrospective review of four cases of gallstone ileus seen at Semeiotica Chirurgica, at Patologia Chirurgica II and Clinica Chirurgica II of Policlinico San Matteo I.R.C.C.S. of Pavia between 1974 and 1989. Three patients were women and one male, with average age 69.4 years. All obstructions occurred in the distal ileum. Proceeding from available data in the literature and from their personal experience the Authors emphasize that gallstone ileus is a rare cause of mechanical obstruction of intestine (4% of the obstructions of the small bowel). This disease usually occurs in elderly women, with concomitant illness. Approximately 50 per cent of the patients have an history of gallbladder disease. The authors discuss the controversy on performing an enterolithotomy alone versus one stage procedure consisting of removal of the impacted stone, fistula repair and cholecystectomy. The prognosis is severe. High mortality and many postoperative complications are caused by the advanced age of the patients, concomitant illness and usually delayed diagnosis.