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Gallstone Ileus

Gallstone Ileus is a topic covered in the 5-Minute Emergency Consult.

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  • 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
  • Cholecystocolonic 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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Rosen, Peter, et al., editors. "Gallstone Ileus." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307416/all/Gallstone_Ileus.
Gallstone Ileus. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307416/all/Gallstone_Ileus. Accessed April 20, 2019.
Gallstone Ileus. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307416/all/Gallstone_Ileus
Gallstone Ileus [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 20]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307416/all/Gallstone_Ileus.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Gallstone Ileus ID - 307416 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307416/all/Gallstone_Ileus PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -