Gallstone ileus is a blockage of the intestine caused by a gallstone. Symptoms include abdominal pain, vomiting, and swelling. Surgery is usually required to remove the stone. Older women are more susceptible, and diagnosis involves X-rays and rehydration. Surgery can be complicated, and about 20% of patients do not survive.
Gallstone ileus is a condition in which the intestine becomes blocked by a gallstone. A gallstone forms within the gallbladder before cutting through the gallbladder wall and into a nearby stretch of intestine. Symptoms of abdominal pain and vomiting may occur, and the abdomen typically becomes swollen. Over time, due to intestinal obstruction, the person becomes unable to pass either gas or stool. Surgery is usually needed to remove lodged or impacted gallstones.
Older women are more likely to develop gallstone ileus. In the early stages of the disorder, what is known as fistula formation occurs, where an abnormal channel develops between the gallbladder and intestines. This happens when a gallstone travels through the wall of the diseased gallbladder and reaches the closest piece of intestine, which is typically the duodenum, the tube that exits the stomach. From there, the stone passes along the intestine, most often wedging itself in a part of the intestine known as the terminal ileum.
Symptoms of gallstone ileus are similar to those of other types of mechanical intestinal obstruction, and alternative causes of the blockage, such as tumors or scarring from surgery or infection, should be ruled out. Vomiting and abdominal pain occur initially before subsiding as the stone moves through the intestines. These symptoms then reappear when the gallstone becomes trapped in the terminal ileum. Vomiting can cause dehydration of the person. The abdomen is usually swollen and may feel tender when touched, and loud bowel sounds may be heard.
Diagnosing gallstone ileus usually involves taking an X-ray of the abdomen, which typically reveals the stone itself, along with signs that show the intestines are blocked. After diagnosis, steps are taken to rehydrate the patient by giving fluids into a vein. A tube may be passed 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 done for any other stones that may be present in the intestine at the same time. Sometimes the gallbladder is removed as part of the same surgical procedure, if the person has a history of having gallstones. In other cases, a second operation to take out the gallbladder may be done. Because the condition of gallstone ileus tends to affect the elderly and frail, about a fifth of patients do not survive, and complications after surgery are common.
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