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 2^ndmost 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

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