Gallstone ileus

A rare form of small bowel obstruction caused by an impaction of a gallstone within the lumen of the small intestine.

Such a gallstone enters the bowel via a cholecysto-enteric fistula.

Large stones, >2.5 cm in diameter, within the gallbladder are thought to predispose to fistula formation by gradual erosion through the gallbladder fundus.

A stone may travel from the gallbladder into the bowel through the fistula and become lodged almost anywhere along the GI tract.

Obstruction occurs most commonly at the near the distal ileum.

Obstruction occurs, usually within 60 cm proximally to the ileocecal valve.

Rarely, gallstone ileus may recur if the underlying fistula is not treated.

Diagnosis requires radiographic studies.

Classic radiographic findings are known as Rigler’s triad of pneumobilia,
evidence of small bowel obstruction and radiopaque gallstone on abdominal X-rays.

Diagnosis is often delayed because at least half the patients do not have laboratory abnormalities or history that suggests biliary disease.

The obstructing stone is frequently radiolucent on plane films, complicating the diagnosis.

Initial management involves fluid resuscitation and potentially nasogastric suctioning.

It constitutes a form of mechanical small bowel obstruction.

It can be a surgical emergency.

It requires open or laparoscopic surgery to remove an impacted stone.

Surgical management may include either enterolithotomy alone, allowing a delayed cholecystectomy after an inflammation-free period of 4–6 weeks or enterolithotomy in combination with a cholecystectomy and fistula division.

Endoscopic removal of the gallstone is possible

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