Chapter 53: Biliary Tract- Gallstone Ileus

Question 1

What is it?

Answer 1

Small bowel obstruction from a large gallstone (>2.5 cm) that has eroded through the gallbladder and into the duodenum/small bowel

Question 2

What is the classic site of obstruction?

Answer 2

Ileocecal valve (but may cause obstruction in the duodenum, sigmoid colon)

Question 3

What are the classic findings of gallstone ileus?

Answer 3

Question 4

What is the population at risk?

Answer 4

Gallstone ileus is most commonly seen in women >70 years

Question 5

What are the signs/symptoms?

Answer 5

Symptoms of SBO: distention, vomiting, hypovolemia, RUQ pain

Question 6

Gallstone ileus causes what percentage of cases of SBO?

Answer 6

<1%

Question 7

What are the diagnostic tests of choice?

Answer 7

Abdominal x-ray:

• occasionally reveals radiopaque gallstone in the bowel
• 40%of patients show air in the biliary tract
• small bowel distention and airfluid levels secondary to ileus

UGI:

• used if diagnosis is in question;
• will show cholecystenteric fistula and the obstruction

Abdominal CT scan: reveals air in biliary tract, SBO ± gallstone in intestine

Question 8

What is the management?

Answer 8

Surgery: enterotomy with removal of the stone ± interval cholecystectomy(interval delayed)