Gallstone ileus

Gallstone ileus is a rare form of small bowel obstruction caused by an impaction of a gallstone within the lumen of the small intestine. Such a gallstone is hypothesized to enter the bowel via a cholecysto-enteric fistula. The presence of large stones, >2.5 cm in diameter, within the gallbladder are thought to predispose to fistula formation by gradual erosion through the gallbladder fundus.[1] Once a fistula has formed, a stone may travel from the gallbladder into the bowel and become lodged almost anywhere along the GI tract. Obstruction occurs most commonly at the near the distal ileum, within 60 cm proximally to the ileocecal valve.[2][3]

The name "gallstone ileus" is a misnomer because an ileus is, by definition, a non-mechanical bowel motility failure (as opposed to a mechanical obstruction by a stone).

Diagnosis

Diagnosis of gallstone ileus requires radiographic studies. Classic radiographic findings are known as Rigler's triad:[4]

Treatment

Initial management involves fluid resuscitation and potentially nasogastric suctioning.[1] Since gallstone ileus constitutes a form of mechanical small bowel obstruction, it can be a surgical emergency and requires laparoscopic removal or propulsion of impacted stone.[1]

Eponym

Bouveret's Syndrome: reverse gallstone ileus where the gallstone propagates proximally and causes gastric outlet obstruction by being impacted in first part of duodenum.

References

  1. 1 2 3 Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Chapter 311. Diseases of the Gallbladder and Bile Ducts. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012. http://www.accessmedicine.com/content.aspx?aID=9135488. Accessed December 17, 2013.
  2. ↑ Gaillard F. Radiopaedia.org - Gallstone Ileus. http://radiopaedia.org/cases/gallstone-ileus. Accessed December 17, 2013
  3. ↑
  4. ↑ Jones J, Gaillard F. Radiopaedia.org - Rigler's Triad. http://radiopaedia.org/articles/riglers-triad. Accessed December 17, 2013
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