Gallstone Ileus



  • 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

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