Gallstone ileus is a rare form of

small bowel obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs an ...

caused by an impaction of a

gallstone A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of mi ...

within the lumen of the small intestine. Such a gallstone enters the bowel via a cholecysto-

enteric The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...

fistula A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow or ...

. 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 In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, although ...

fundus. Once a fistula has formed, a stone may travel from the gallbladder into the bowel and become lodged almost anywhere along the gastrointestinal tract. Obstruction occurs most commonly at the near the distal

ileum The ileum () is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine m ...

, within 60 cm proximally to the ileocecal valve. Rarely, gallstone ileus may recur if the underlying fistula is not treated. First described by

Thomas Bartholin Thomas Bartholin (; Latinized as ''Thomas Bartholinus''; 20 October 1616 – 4 December 1680) was a Danish physician, mathematician, and theologian. He is best known for his work in the discovery of the lymphatic system in humans and for hi ...

in 1654, the name "gallstone ileus" is a misnomer because an

ileus Ileus is a disruption of the normal propulsive ability of the intestine. It can be caused by lack of peristalsis or by mechanical obstruction. The word 'ileus' is from Ancient Greek ''eileós'' (, "intestinal obstruction"). The term 'subileus' ref ...

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 Rigler's triad is a combination of findings on an abdominal radiograph of people with gallstone ileus, a condition where a large gallstone causes bowel obstruction. Rigler's triad consists of: (1) small bowel obstruction, (2) a gallstone outside ...

: *

pneumobilia Pneumobilia is the presence of gas in the biliary system. It is typically detected by ultrasound or a radiographic imaging exam, such as CT, or MRI. It is a common finding in patients that have recently undergone biliary surgery or endoscopic bi ...

(air within the biliary tree) * evidence of small bowel obstruction * radiopaque gallstone on abdominal radiograph

Treatment

Initial management involves fluid resuscitation and potentially nasogastric suctioning. Since gallstone ileus constitutes a form of mechanical small bowel obstruction, it can be a surgical emergency and requires open or laparoscopic surgery to remove an impacted stone. The different strategies for surgical management are either enterolithotomy alone, allowing a delayed cholecystectomy after an inflammation-free period of 4–6 weeks (and therefore two-stage surgery) or enterolithotomy in combination with a cholecystectomy and

division (one-stage surgery). The different strategies for surgical management are controversial, and depend on factors such as patient fitness for surgery and comorbidities.

Eponym

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

References

External links

{{Medical resources , ICD10 = {{ICD10, K56.3 , ICD9 = {{ICD9, xxx , ICDO = , OMIM = , DiseasesDB = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeSH = , GeneReviewsNBK = , GeneReviewsName = , Orphanet = Gastrointestinal tract disorders