What is Gallstone Ileus?

H. Colledge

Gallstone ileus is a condition where the gut becomes blocked by a gallstone. A gallstone forms inside the gallbladder before cutting through the gallbladder wall and into a nearby length of intestine. Symptoms of pain in the abdomen and vomiting may occur, and the abdomen typically becomes swollen. In time, as a result of the intestinal obstruction, the person becomes unable to pass either gas or stools. Surgery is normally required to remove the lodged, or impacted, gallstone.

A healthy gallbladder and one with gallstones.
A healthy gallbladder and one with gallstones.

Elderly women are more likely to develop gallstone ileus. In the first stages of the disorder, what is known as fistula formation occurs, where an abnormal channel develops between the gallbladder and the intestines. This happens when a gallstone breaks through the wall of the diseased gallbladder and into the nearest piece of gut, which is typically the duodenum, the tube leading out of the stomach. From there, the gallstone passes along the intestine, most often becoming wedged in a part of the bowel known as the terminal ileum.

Vomiting is a common symptom of gallstone ileus.
Vomiting is a common symptom of gallstone ileus.

The symptoms of gallstone ileus are similar to those of other types of mechanical bowel obstruction and alternative causes of blockage, such as tumors or scars due to surgery or infection, should be ruled out. Vomiting and abdominal pain occur at first before subsiding as the gallstone moves along the gut. These symptoms then reappear as the gallstone becomes trapped in the terminal ileum. Vomiting may cause the person to become dehydrated. The abdomen is usually bloated and may feel tender when touched, and noisy bowel sounds may be heard.

Diagnosis of gallstone ileus usually involves taking an X-ray of the abdomen, which typically reveals the stone itself, together with signs that show the intestines are blocked. Following diagnosis, steps are taken to rehydrate the patient by giving fluids into a vein. A tube may be passed down into the stomach to empty it and prevent further vomiting.

Traditional or keyhole surgery may be used to remove the gallstone causing the obstruction, and a search is made for any other stones which may be present in the gut at the same time. Sometimes the gallbladder is removed as part of the same surgical procedure, if the person has a history of suffering from gallstones. In other cases, a second operation may be carried out to extract the gallbladder. As the condition of gallstone ileus tends to affect elderly and frail people, around a fifth of patients do not survive, and complications following surgery are common.

A gallstone blocks part of the gut in a patient with gallstone ileus.
A gallstone blocks part of the gut in a patient with gallstone ileus.

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