GALLSTONE ILEUS

GALLSTONE ILEUS


                GALLSTONE ILEUS (GALLSTONES OBSTRUCTION)

  • Gallstone ileus is a rare form of small bowel obstruction caused by an impaction of a gallstone within the lumen of small intestine.
  • It is misnomer, it not a true ileus.
  • It may ulcerate through gall bladder into duodenum and passes small bowel.
  • Gallstone cause mechanical small bowel obstruction larger than 2.5cm.
  • It is asymptomatic.

   

CLINICAL FEATURES-

  • More common in elderly females(>70 years)
  • Single large stone.
  • Gall stones reaches terminal ileum forms “cholecystoduodenal fistula” due to cholecystitis.
  • Terminal ileum is the narrowest point of the gut where gall stone gets impacted.
  • Abdominal pain, vomiting, distension.
  • Step ladder peristalsis seen.
  • MC site of fistula cholecystoduodenal and 2ndmost common site is cholecystocholic.
  • The commonest site of obstruction in Gall stone ileus is DISTAL ILEUM.
  • Rigler’s traid- Small bowel + ectopic gall stone + pneumobilia.

 

INVESTIGATIONS-

  1. X- ray abdomen (erect position)
  • Multiple gas and fluid levels and stones in gall bladder
  • Air may be found in biliary system.

    2. Small bowel enema shows partial obstruction

    3. CT- IOC

  • Diagnosis of gallstone (sensitivity)

   

TREATMENT-

  • Enterotomy and removal of obstruction

Exam Important

CLINICAL FEATURES-

  • More common in elderly females(>70 years)
  • Single large stone.
  • Gall stones reaches terminal ileum forms “cholecystoduodenal fistula” due to cholecystitis.
  • Terminal ileum is the narrowest point of the gut where gall stone gets impacted.
  • Abdominal pain, vomiting, distension.
  • Step ladder peristalsis seen.
  • MC site of fistula cholecystoduodenal and 2ndmost common site is cholecystocholic.
  • The commonest site of obstruction in Gall stone ileus is DISTAL ILEUM.
  • Rigler’s traid- Small bowel + ectopic gall stone + pneumobilia.
TREATMENT-

  • Enterotomy and removal of obstruction
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