Case Report: Gallstone ileus management - Case report and review of the literature

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This study aimed to highlight the complexities surrounding its occurrence and emphasize the need for tailored therapeutic strategies. An 88-year-old female, with a history of type 2 diabetes mellitus presented with diffuse abdominal pain and vomiting. Clinical evaluation revealed signs of small-bowel obstruction. Radiological assessments, including Computed Tomography CT) scans, confirmed biliary ileus, showcasing a sizable gallstone causing subacute obstruction. Emergency surgery involving enterolithotomy was performed, successfully addressing the immediate concerns. Postoperative follow-up demonstrated a one-year asymptomatic period, emphasizing the effectiveness of the chosen intervention. Gallstone ileus typically follows acute cholecystitis, leading to gallstone erosion and fistula formation commonly in the duodenum. Diagnosis is challenging because of nonspecific symptoms, necessitating a high index of suspicion. Computed tomography (CT) plays a pivotal role in accurate and rapid diagnoses. This study delves into the intricate details of gallstone ileus presentation, complications, and the debate surrounding optimal surgical management, acknowledging the effectiveness of the two-stage procedure and emerging laparoscopic approaches. This case provides valuable insights into the intricate facets of gallstone ileus and emphasizes the need for individualized treatment strategies. Successful management, as demonstrated in our case, underscores the importance of considering patient-specific factors when choosing between the surgical approaches. This study supports recent reports advocating for laparoscopic interventions, encouraging further exploration of evolving therapeutic modalities for gallstone ileus." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-823", "name": "Case Report: Gallstone ileus management - Case report and review of..." } } ] } Home Browse Case Report: Gallstone ileus management - Case report and review of... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Dallagi R, Ferjaoui W, Omry A et al. Case Report: Gallstone ileus management - Case report and review of the literature [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :823 ( https://doi.org/10.12688/f1000research.154006.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Gallstone ileus management - Case report and review of the literature [version 1; peer review: 1 approved, 1 not approved] Rania Dallagi 1 , Wael Ferjaoui 1 , Ahmed Omry https://orcid.org/0009-0007-7847-3106 1 , Hager Behi 1 , Med Bachir Khalifa 1 Rania Dallagi 1 , Wael Ferjaoui 1 , [...] Ahmed Omry https://orcid.org/0009-0007-7847-3106 1 , Hager Behi 1 , Med Bachir Khalifa 1 PUBLISHED 23 Jul 2024 Author details Author details 1 General surgery department, Military hospital of Tunis, Tunis, 1008, Tunisia Rania Dallagi Roles: Investigation, Writing – Original Draft Preparation Wael Ferjaoui Roles: Conceptualization, Supervision Ahmed Omry Roles: Writing – Original Draft Preparation Hager Behi Roles: Supervision, Writing – Review & Editing Med Bachir Khalifa Roles: Validation OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Gallstone ileus, a rare complication of cholelithiasis, presents significant morbidity and mortality challenges, with no established consensus on optimal management. This study aimed to highlight the complexities surrounding its occurrence and emphasize the need for tailored therapeutic strategies. An 88-year-old female, with a history of type 2 diabetes mellitus presented with diffuse abdominal pain and vomiting. Clinical evaluation revealed signs of small-bowel obstruction. Radiological assessments, including Computed Tomography CT) scans, confirmed biliary ileus, showcasing a sizable gallstone causing subacute obstruction. Emergency surgery involving enterolithotomy was performed, successfully addressing the immediate concerns. Postoperative follow-up demonstrated a one-year asymptomatic period, emphasizing the effectiveness of the chosen intervention. Gallstone ileus typically follows acute cholecystitis, leading to gallstone erosion and fistula formation commonly in the duodenum. Diagnosis is challenging because of nonspecific symptoms, necessitating a high index of suspicion. Computed tomography (CT) plays a pivotal role in accurate and rapid diagnoses. This study delves into the intricate details of gallstone ileus presentation, complications, and the debate surrounding optimal surgical management, acknowledging the effectiveness of the two-stage procedure and emerging laparoscopic approaches. This case provides valuable insights into the intricate facets of gallstone ileus and emphasizes the need for individualized treatment strategies. Successful management, as demonstrated in our case, underscores the importance of considering patient-specific factors when choosing between the surgical approaches. This study supports recent reports advocating for laparoscopic interventions, encouraging further exploration of evolving therapeutic modalities for gallstone ileus. READ ALL READ LESS Keywords Gallstone ileus, Cholecysto-duodenal fistula, Small bowel obstruction, Case report Corresponding Author(s) Ahmed Omry ( [email protected] ) Close Corresponding author: Ahmed Omry Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Dallagi R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Dallagi R, Ferjaoui W, Omry A et al. Case Report: Gallstone ileus management - Case report and review of the literature [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :823 ( https://doi.org/10.12688/f1000research.154006.1 ) First published: 23 Jul 2024, 13 :823 ( https://doi.org/10.12688/f1000research.154006.1 ) Latest published: 23 Jul 2024, 13 :823 ( https://doi.org/10.12688/f1000research.154006.1 ) Introduction Small bowel obstruction triggered by gallstones is a rare complication of cholelithiasis. 1 , 2 It is defined as a mechanical obstruction of the intestine caused by the entrapment of a sizable gallstone that perforates the gallbladder wall, leading to the formation of a biliary digestive fistula. 1 This condition arises in approximately 0.3 to 0.5% of individuals with cholelithiasis. 3 , 4 It is associated with comparatively elevated rates of morbidity and mortality. 1 , 2 There is no consensus regarding the optimal management of gallstone ileus. 5 , 6 The present case involved a subacute small bowel obstruction caused by a gallstone, which was addressed through open enterolithotomy. Through this case report and literature review, our aim was to underscore the conditions leading to the development of this pathology, as well as the challenges associated with clinical and paraclinical diagnosis and therapy. Case presentation We report the case of an 88-year-old female patient with a history of type 2 diabetes on oral antidiabetic medication and no surgical history. The patient presented to the emergency department with diffuse abdominal pain accompanied by early postprandial vomiting and cessation of bowel movements and gas, which persisted for the last two days. She denied having fever, jaundice, melena, discolored urine, or abdominal trauma preceding the onset of symptoms. Physical examination revealed that the patient was hemodynamically stable without jaundice or fever. Abdominal examination revealed a distended tympanic abdomen with tenderness on palpation in the suprapubic and periumbilical regions. The hernial orifices were free, and rectal examination indicated normal-colored stools. Laboratory results indicated a biological inflammatory syndrome with a white blood cell count of 15,000 cells/mm 3 and C-reactive protein (CRP) level of 100 mg/L. The remaining laboratory findings, including liver function test results, were within the normal range. An unprepared abdomen showed small bowel air-fluid levels with an approximately 4 cm round pelvic opacity ( Figure 1 ). Further exploration using an abdominal CT scan revealed a dilated proximal small bowel with a maximum measured diameter of 40 mm upstream of a transitional level consisting of a distended loop with a flattened appearance. At this level, an intraluminal stone measuring 3 cm in diameter was observed. In addition, there were no radiological signs of intestinal distress. The scan also indicated a multilithiatic gallbladder with a cholecystoduodenal fistula confirmed by an intra-vesicular air bubble ( Figure 2 ). Furthermore, no intra-abdominal fluid was found. A diagnosis of biliary ileus was made. Figure 1. Unprepared abdomen showing air-fluid levels with a round pelvic opacity (white arrow). Figure 2. Computed Tomography (CT) scan image displaying an air bubble in the gallbladder (white arrow). After admission, the patient underwent a hydration and analgesia protocol. A urinary catheter and nasogastric tube for gentle aspiration were inserted, yielding a fecaloid-looking fluid. Subsequently, the patient underwent emergency surgery via a midline approach. Intraoperative exploration revealed a dilated and viable proximal small bowel upstream of an intraluminal stone located 1 m 30 cm from the ligament of Treitz and 1 m 50 cm from the ileocecal valve ( Figure 3 ). The distal small bowel and colon were flat and normal, respectively. An inflammatory mass involving the gallbladder, duodenum, right colic angle, and omentum was identified. An enterotomy was performed in a non-inflammatory healthy area, through which the stone was extracted ( Figure 4 ). The opening was closed in two layers using Vicryl 3/0. We decided to postpone any additional procedures, such as cholecystectomy or closure of the cholecystoduodenal fistula, given the patient’s age and intraoperative findings. The intervention included peritoneal lavage using warm saline and drainage of the Douglas pouch. Postoperative recovery was uneventful, with the patient being allowed a regular diet from postoperative day 1 and discharged on postoperative day 4. The patient remained asymptomatic during one year of follow-up at the outpatient clinic, and radiological control showed spontaneous closure of the biliary digestive fistula. Figure 3. Intraoperative view showing the gallstone enclaved in the small bowel (white star). Figure 4. Intraoperative image showing the extraction of the stone through the enterotomy. Discussion Gallstone ileus is a rare complication of cholelithiasis, occurring in less than 0.5% of patients who present with mechanical small-bowel obstruction. 2 , 3 , 7 It has a higher incidence in females and older individuals, as in our case. 1 , 8 Gallstone ileus (GI) is typically preceded by an initial acute cholecystitis. 1 , 2 , 9 Inflammation affecting the gallbladder and its adjacent structures, compounded by the pressure exerted by the gallstone, can result in erosion of the gallbladder wall, ultimately leading to fistula formation. 1 , 10 Fistulas connecting the gallbladder and gastrointestinal tract commonly manifest in the duodenum owing to their proximity. 4 Other regions of the gastrointestinal tract may also be implicated, including the stomach, small intestine, and transverse colon. 1 , 11 Because of their narrow lumens, the terminal ileum and ileocecal valve are frequently the primary locations of gallstone ileus. 1 Gallstones causing small bowel obstruction (SBO) typically exceeding 2.5 cm. 1 , 4 , 6 In our case, gallstone ileus manifested in the jejunum due to the considerable size of the gallstone (4 cm). Diagnosis is often challenging because of nonspecific or incomplete symptoms, such as intense abdominal pain, nausea, vomiting, inability to pass gas or stool, and hematochezia. 6 Physical examinations may reveal abdominal distension and tenderness, decreased or absent bowel sounds, jaundice, and signs of dehydration. 6 Biochemical markers may appear normal or lack specificity, potentially featuring findings such as leukocytosis and abnormalities in electrolyte levels, as observed in our patient. 9 CT scans exhibit high sensitivity and specificity in diagnosing gallstone ileus, with rates of 93% and 100%, respectively. 1 , 10 Therefore, a heightened level of suspicion is essential in individuals with a history of gallstones who present with bowel obstruction. 9 Rigler’s triad delineates classical imaging features indicative of gallstone ileus: (1) intestinal obstruction, (2) pneumobilia, (3) gallstone within the intestinal lumen, and more recently, a change in the position of the gallstone observed in serial imaging. 3 , 9 There is no consensus regarding the surgical management of gallstone ileus. 1 , 5 , 12 Laparotomy is commonly considered to be the preferred method. 1 The treatment objective is to alleviate obstruction by focusing on gallstone extraction. 9 Surgical options encompass a one-stage approach involving enterolithotomy, cholecystectomy, and fistula closure or a two-stage procedure with enterolithotomy, cholecystectomy, and subsequent fistula closure. 1 In our case, we performed only an enterotomy with stone extraction, considering the patient’s condition and the highly inflammatory mass formed by the gallbladder, thereby reducing postoperative morbidity. The one-stage procedure helps prevent the recurrence of gallstone ileus, with rates ranging from 8 to 33%. 1 Nevertheless, this approach is technically challenging and associated with increased morbidity and mortality, particularly in older patients with comorbidities. 1 , 6 , 8 In contrast, the two-stage procedure is more straightforward and requires a shorter operative time. 1 As a result, it has emerged as a safer option for patients with compromised general conditions, dehydration, sepsis, and shock. 1 Recently, laparoscopic management has been reported cases of laparoscopic management. 1 This approach has proven to be both effective and safe, particularly in the context of a two-stage procedure. In conclusion, we present a novel case of gallstone ileus that was successfully treated using a two-stage procedure. The choice of surgical approach should be tailored to factors such as the patient’s overall health, hemodynamic status, local conditions, and surgeon’s expertise. 1 Conclusion Gallstone ileus (GI) is a rare complication of cholelithiasis, particularly in females and older individuals. 5 , 9 Our case, successfully treated with an enterotomy, highlights the challenges in diagnosis and emphasizes the importance of individualized surgical approaches based on patient characteristics. The choice between one- and two-stage procedures depends on the overall health of the patient. 1 Recent reports have suggested that laparoscopic management is a safe and effective option. This case contributes to our understanding of gallstone ileus and underscores the need for tailored treatment. Ethics and consent Ethical approval were not required. Written informed consent for the publication of this case and the associated images was obtained from the patient. Data availability No data are associated with this article. References 1. Beji H, Chtourou MF, Zribi S, et al. : Gallstone ileus: A case report and review of the literature. Int. J. Surg. Case Rep. 2023 May; 106 : 108221. PubMed Abstract | Publisher Full Text | Free Full Text 2. Shrestha N, Mishra A, Ghimire R: An unusual case of subacute small bowel obstruction - Gallstone ileus. Int. J. Surg. Case Rep. 2022 Mar; 92 : 106820. PubMed Abstract | Publisher Full Text | Free Full Text 3. Falgowski T, Pawlus J, Malanowska E, et al. : Gallstone ileus – case description and literature review. 4. Suro-Santos Y, Serrato-Ruíz JA, Fuentes-Hernández JE, et al. : Biliary ileus an uncommon cause of intestinal occlusion: case report. HGMX. 2023 Feb 8; 86 (1): 9676. Publisher Full Text 5. Vera-Mansilla C, Sanchez-Gollarte A, Matias B, et al. : Surgical Treatment of Gallstone Ileus: Less Is More. Visc. Med. 2022; 38 (1): 72–77. PubMed Abstract | Publisher Full Text | Free Full Text 6. Inukai K: Gallstone ileus: a review. BMJ Open Gastroenterol. 2019 Nov; 6 (1): e000344. PubMed Abstract | Publisher Full Text | Free Full Text 7. Muñoz-Leija MA, Alemán-Jiménez MC, Quiroga-Garza A, et al. : Gallstone Ileus in a Young Patient: A Clinical Case Report and Literature Review. Cureus. 2023 Jan 3 [cited 2024 Jan 1]; 15 : e33291. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 8. Morosin T, De Robles MSB, Putnis S: Gallstone Ileus: An Unusual Cause of Intestinal Obstruction. Cureus. 2020 Mar 15 [cited 2024 Jan 1]; 12 : e7284. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 9. Boudou M, Jabi R, Maamar K, et al. : A febrile occlusion revealing a biliary ileus. Int. J. Surg. Case Rep. 2022 May; 94 : 107113. PubMed Abstract | Publisher Full Text | Free Full Text 10. Pichardo J, Zapata J, Echavarría R, et al. : Gallstone Ileus With Cholecystoenteric Fistula in an Elderly Female: A Case Report. Cureus. 2023 Apr 3 [cited 2024 Jan 1]; 15 : e37077. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 11. Kirchmayr W, Mühlmann G, Zitt M, et al. : GALLSTONE ILEUS: RARE AND STILL CONTROVERSIAL. ANZ J. Surg. 2005 Apr; 75 (4): 234–238. PubMed Abstract | Publisher Full Text 12. Dreifuss NH, Schlottmann F, Cubisino A, et al. : Totally laparoscopic resolution of gallstone ileus: A case report. Int. J. Surg. Case Rep. 2022 Jan; 90 : 106682. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 23 Jul 2024 ADD YOUR COMMENT Comment Author details Author details 1 General surgery department, Military hospital of Tunis, Tunis, 1008, Tunisia Rania Dallagi Roles: Investigation, Writing – Original Draft Preparation Wael Ferjaoui Roles: Conceptualization, Supervision Ahmed Omry Roles: Writing – Original Draft Preparation Hager Behi Roles: Supervision, Writing – Review & Editing Med Bachir Khalifa Roles: Validation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 23 Jul 2024, 13:823 https://doi.org/10.12688/f1000research.154006.1 Copyright © 2024 Dallagi R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Dallagi R, Ferjaoui W, Omry A et al. Case Report: Gallstone ileus management - Case report and review of the literature [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :823 ( https://doi.org/10.12688/f1000research.154006.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 23 Jul 2024 Views 0 Cite How to cite this report: Uttam S. Reviewer Report For: Case Report: Gallstone ileus management - Case report and review of the literature [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :823 ( https://doi.org/10.5256/f1000research.168978.r319563 ) The direct URL for this report is: https://f1000research.com/articles/13-823/v1#referee-response-319563 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Sep 2024 Sarthak Uttam , Sarojini Naidu Medical College, Agra, UP, India Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.168978.r319563 Hello dear researcher, This case report is well written and structured but i have a few queries which i would love to be addressed. 1. usually patients with gall stone ileus present with past history of multiple episodes ... Continue reading READ ALL Hello dear researcher, This case report is well written and structured but i have a few queries which i would love to be addressed. 1. usually patients with gall stone ileus present with past history of multiple episodes of recurring cholecystitic pain and discomfort. Was it the case here ? 2. the ct image of pnemobilia appears a little dubious to me, can you provide a cross sectional axial image to delineate the air in gall bladder and the enteral stone ? and is there a cholecystoduodenal fistule that can be spotted in ct scan ? 3. was an ultrsonography of gall bladder soughted before surgery ? usg has better sensitivity for gall stones that ct scan. 4. was the enterotomy for stone extraction done proximal or distal to the site of stone impaction ? and was the remaining bowel thoroughly inspected for other stones that might have been missed in imaging because you mentioned GB was 'multilithiatic'. 5. it there were stones in gall bladder there is apparent risk for recurrences. what was the plan for management of remnant stones ? how was the patient followed ? and was there a scope of getting endoscopy done during the follow up to look for fistula healing ? 6. you mentioned in the management that patient recovered with spontaneous closure of the fistula, but in discussion you mention that a two staged procedure was followed. this is highly contradicting and please mention the details of second procedure done. These questions i feel are important in terms of patient follow up and in preventing recurrences in this old age lady who is a known diabetic. Mention of these details would make your report more complete and inclusive. kindly refer to the citations attached. thankyou. Is the background of the case’s history and progression described in sufficient detail? No Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly References 1. Uttam S, Kumar S, Singh S, Singh S, et al.: Gallstone ileus- A rare presentation in the era of rampant cholecystectomies. International Journal of Surgery Case Reports . 2024; 119 . Publisher Full Text 2. Shioi Y, Kawamura S, Kanno K, Nishinari Y, et al.: A case of gallstone ileus displaying spontaneous closure of cholecystoduodenal fistula after enterolithotomy. Int J Surg Case Rep . 2012; 3 (1): 12-5 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: general surgery, GI surgery. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Uttam S. Reviewer Report For: Case Report: Gallstone ileus management - Case report and review of the literature [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :823 ( https://doi.org/10.5256/f1000research.168978.r319563 ) The direct URL for this report is: https://f1000research.com/articles/13-823/v1#referee-response-319563 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Seifarth F. Reviewer Report For: Case Report: Gallstone ileus management - Case report and review of the literature [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :823 ( https://doi.org/10.5256/f1000research.168978.r311699 ) The direct URL for this report is: https://f1000research.com/articles/13-823/v1#referee-response-311699 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Aug 2024 Federico Seifarth , West Virginia University Medicine Children's Hospital, Morgantown, WV, USA Approved VIEWS 0 https://doi.org/10.5256/f1000research.168978.r311699 This case report describes an elderly female patient suffering from gallstone ileus, a rare complication of cholelithiasis. The authors describe the history, clinical presentation, diagnostics and therapeutic considerations of treatment and the surgical procedure. In general, surgery is ... Continue reading READ ALL This case report describes an elderly female patient suffering from gallstone ileus, a rare complication of cholelithiasis. The authors describe the history, clinical presentation, diagnostics and therapeutic considerations of treatment and the surgical procedure. In general, surgery is the accepted treatment of choice for such cases. I would therefore not postulate a "lack of consensus of management" but rather mention the challenges in diagnosis and discuss the different surgical technical options. The images are appropriate. Figure 2 shows pneumobilia which is present in 30-60% of all patients and should also be called as such. The authors should also discuss the diagnostic value of ultrasound and HIDA scans in the discussion and mention the rare event of an impaction of a large gallstone within the pyloric channel (Bouveret syndrome). This case does not represent a novel case of gallstone ileus (last paragraph) but discusses presentation, workup and therapy of this rare but well described pathology in elderly women. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Reisner RM, Cohen JR: Gallstone ileus: a review of 1001 reported cases. Am Surg . 1994; 60 (6): 441-6 PubMed Abstract 2. Clavien PA, Richon J, Burgan S, Rohner A: Gallstone ileus. Br J Surg . 1990; 77 (7): 737-42 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Minimally invasive surgery, pediatric surgery. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Seifarth F. Reviewer Report For: Case Report: Gallstone ileus management - Case report and review of the literature [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :823 ( https://doi.org/10.5256/f1000research.168978.r311699 ) The direct URL for this report is: https://f1000research.com/articles/13-823/v1#referee-response-311699 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 23 Jul 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 23 Jul 24 read read Federico Seifarth , West Virginia University Medicine Children's Hospital, Morgantown, USA Sarthak Uttam , Sarojini Naidu Medical College, Agra, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Uttam S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Sep 2024 | for Version 1 Sarthak Uttam , Sarojini Naidu Medical College, Agra, UP, India 0 Views copyright © 2024 Uttam S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Hello dear researcher, This case report is well written and structured but i have a few queries which i would love to be addressed. 1. usually patients with gall stone ileus present with past history of multiple episodes of recurring cholecystitic pain and discomfort. Was it the case here ? 2. the ct image of pnemobilia appears a little dubious to me, can you provide a cross sectional axial image to delineate the air in gall bladder and the enteral stone ? and is there a cholecystoduodenal fistule that can be spotted in ct scan ? 3. was an ultrsonography of gall bladder soughted before surgery ? usg has better sensitivity for gall stones that ct scan. 4. was the enterotomy for stone extraction done proximal or distal to the site of stone impaction ? and was the remaining bowel thoroughly inspected for other stones that might have been missed in imaging because you mentioned GB was 'multilithiatic'. 5. it there were stones in gall bladder there is apparent risk for recurrences. what was the plan for management of remnant stones ? how was the patient followed ? and was there a scope of getting endoscopy done during the follow up to look for fistula healing ? 6. you mentioned in the management that patient recovered with spontaneous closure of the fistula, but in discussion you mention that a two staged procedure was followed. this is highly contradicting and please mention the details of second procedure done. These questions i feel are important in terms of patient follow up and in preventing recurrences in this old age lady who is a known diabetic. Mention of these details would make your report more complete and inclusive. kindly refer to the citations attached. thankyou. Is the background of the case’s history and progression described in sufficient detail? No Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly References 1. Uttam S, Kumar S, Singh S, Singh S, et al.: Gallstone ileus- A rare presentation in the era of rampant cholecystectomies. International Journal of Surgery Case Reports . 2024; 119 . Publisher Full Text 2. Shioi Y, Kawamura S, Kanno K, Nishinari Y, et al.: A case of gallstone ileus displaying spontaneous closure of cholecystoduodenal fistula after enterolithotomy. Int J Surg Case Rep . 2012; 3 (1): 12-5 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise general surgery, GI surgery. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Uttam S. Peer Review Report For: Case Report: Gallstone ileus management - Case report and review of the literature [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :823 ( https://doi.org/10.5256/f1000research.168978.r319563) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-823/v1#referee-response-319563 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Seifarth F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 21 Aug 2024 | for Version 1 Federico Seifarth , West Virginia University Medicine Children's Hospital, Morgantown, WV, USA 0 Views copyright © 2024 Seifarth F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This case report describes an elderly female patient suffering from gallstone ileus, a rare complication of cholelithiasis. The authors describe the history, clinical presentation, diagnostics and therapeutic considerations of treatment and the surgical procedure. In general, surgery is the accepted treatment of choice for such cases. I would therefore not postulate a "lack of consensus of management" but rather mention the challenges in diagnosis and discuss the different surgical technical options. The images are appropriate. Figure 2 shows pneumobilia which is present in 30-60% of all patients and should also be called as such. The authors should also discuss the diagnostic value of ultrasound and HIDA scans in the discussion and mention the rare event of an impaction of a large gallstone within the pyloric channel (Bouveret syndrome). This case does not represent a novel case of gallstone ileus (last paragraph) but discusses presentation, workup and therapy of this rare but well described pathology in elderly women. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Reisner RM, Cohen JR: Gallstone ileus: a review of 1001 reported cases. Am Surg . 1994; 60 (6): 441-6 PubMed Abstract 2. Clavien PA, Richon J, Burgan S, Rohner A: Gallstone ileus. Br J Surg . 1990; 77 (7): 737-42 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Minimally invasive surgery, pediatric surgery. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Seifarth F. Peer Review Report For: Case Report: Gallstone ileus management - Case report and review of the literature [version 1; peer review: 1 approved, 1 not approved] . F1000Research 2024, 13 :823 ( https://doi.org/10.5256/f1000research.168978.r311699) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-823/v1#referee-response-311699 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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