Gallstone Ileus

Basics

Mechanical intestinal obstruction secondary to impaction of a gallstone within bowel lumen
Stone is usually >2.5 cm
1–3% of all intestinal obstructions
Most cases occur in patients >65
Female > male (5:1)
Mortality 15–18%

Chronic gallbladder inflammation causes adhesions between gallbladder and adjacent bowel wall
Biliary-enteric fistula develops, permitting stone passage into intestine:
- Duodenum is the most common site of fistula formation, followed by colon
- Gastric fistulas are possible but rare
Site of impaction
- Terminal ileum most common (54–65%)
  - Narrowest part of small intestine at level of ileocecal valve
- Jejunum (27%)
- Duodenum (1–3%)
  - Gastric outlet obstruction caused by duodenal impaction referred to as Bouveret syndrome
Large bowel obstruction is rare

There's more to see -- the rest of this topic is available only to subscribers.