Treatment Outcomes in Patients with Biliary Ileus

Introduction. Although uncommon, biliary ileus is a severe complication of gallstone disease, occurring primarily in elderly patients and associated with high mortality. Aim. This study examined the clinical presentation, diagnostic features, and surgical management of biliary ileus and evaluated the effectiveness of different treatment strategies based on 15 years of clinical experience.

Materials and methods. A retrospective analysis was performed on 37 patients (32 women, 5 men; mean age 71.4 ± 9.6 years) treated in the surgical departments of three clinics in the Central region of Russia between 2010 and 2024. A cholecystoduodenal fistula was identified in 75.6% of cases, and the ileum was the most common site of gallstone impaction (62.1%).

Results. A strong association was observed between the stage of intestinal obstruction, the severity of hemodynamic disturbances, and the degree of endogenous intoxication. Mortality ranged from 7.5–10% in compensated obstruction, 15–20% in subcompensation, and 30–35% in decompensation. The primary surgical approach was isolated enterolithotomy (81.1%), which demonstrated the lowest complication rates (6.6%) and mortality (6.6%). In contrast, mortality after bowel resection reached 50%. Discussion. Radical procedures involving cholecystectomy and fistula repair are indicated only in patients with stable hemodynamics and acceptable somatic status. The degree of endogenous intoxication correlates with the severity of intestinal obstruction. These findings confirm that early diagnosis, careful hemodynamic assessment, and evaluation of endogenous intoxication are critical for selecting an appropriate treatment strategy.

Conclusion. An individualized approach and prioritization of organ‑preserving procedures reduce complication rates, shorten hospitalization, and improve prognosis in patients with biliary ileus.

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