Gallstone Ileus

Basics

Description

  • Mechanical intestinal obstruction secondary to impaction of a gallstone within bowel lumen
  • Stone is usually >2.5 cm
  • Biliary-enteric fistula allows passage for stone into intestine
  • Rare 0.5% of all intestinal obstructions
  • Most cases occur in patients >65, female sex
  • Mortality 15–18%

Etiology

  • 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
    • Cholecystocolonic and cholecystogastric fistulas are possible but rare
  • Site of impaction:
    • Terminal ileum most common (50–70%):
      • Narrowest part of small intestine at level of ileocecal valve
    • Jejunum (27%)
    • Stomach/duodenum (1–3%):
      • Gastric outlet obstruction caused by duodenal impaction referred to as Bouveret syndrome
  • Large bowel obstruction is rare and usually where there is preexisting stricture

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