Gallstone Ileus
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Basics
Description
- 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%
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, 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
- Terminal ileum most common (54–65%)
- Large bowel obstruction is rare
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Basics
Description
- 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%
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, 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
- Terminal ileum most common (54–65%)
- Large bowel obstruction is rare
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