Gallstone ileus:

Gallstone ileus: Gallstone ileus refers to intestinal obstruction caused by a gallstone that has eroded/fistulized into the gastrointestinal tract. Rigler's triad on abdominal radiographs: Air in the biliary tree (pneumobilia) Partial or complete bowel obstruction; and An ectopic gallstone. (Bowel obstruction is most commonly seen. Air in the biliary tract is present in about two-thirds of patients, and the calcified stone is noted 25-50% of patients). In the majority of patients, the gallstone will pass through the intestinal tract without resulting in obstruction. Stones larger than 2.5 cm usually cause a mechanical obstruction. The point of obstruction is generally in the ileum or at the ileocecal valve (76%), in the duodenum (21%) or sigmoid colon (2%). The site of communication between the biliary tract and the intestine is most commonly at the duodenum or colon. Gallstone obstruction in the colon will usually be located at the site of disease such as sigmoid diverticulosis or at a surgical anastomosis. Gastric outlet obstruction, Bouveret's syndrome, occurs when the gallstone erodes and lodges into the stomach or duodenal bulb. Gallstone ileus is seen more commonly in the elderly ~ 70 years old. If the conventional radiographic findings are indefinite, CT or UGI-small bowel series will assist in establishing the diagnosis. Clinical management is enterolithotomy with or without cholecystectomy to prevent future occurrence. References: Zeman RK. Cholelithiasis and cholecystitis. In: Gore RM, Levine MS (eds). Textbook of Gastrointestinal Radiology, 2nd ed. Philadelphia: WB Saunders; 2000:1335-1336. Lobo DN, Jobling JC, Balfour TW. Gallstone ileus: diagnostic pitfalls and therapeutic successes. J Clin Gastroenterol 2000; 30:72-76. Day EA, Mark C. Gallstone ileus: a review of the literature and presentation of 34 new cases. Am J Surg 1975; 129:552-558. Delabrousse E, Bartholomot B, Sohm O, et a;. Gallstone ileus: CT findings. Eur Radiol 2000; 10:938-940. Loren I, Lasson A, Nilsson A, et al. Gallstone ileus demonstrated by CT. J Comput Assist Tomogr 1994; 18:262-265.