Gallstone ileus

Aetiology:

• A gallbladder which contains stones erodes into adjacent small bowel, usually the duodenum
• Stones can then be shed through this cholecystenteric fistula into the gut
• A stone that has a diameter greater than the narrowest part of the small bowel (the terminal ileum) may impact to produce lower small bowel obstruction.

Clinical features:

• Vague attacks of colic as the stone passes down the gut
• Eventually, signs of a low small bowel obstruction

Investigations:

In addition to the characteristic features of a small bowel obstruction on an AXR, it may be possible to see:

• Aerobilia (air in the biliary tree)
• A gallstone in the RLQ

Mx:

• Surgical