Gallstone ileus

 Q: Gallstone ileus is due to? (select one) 

A) mechanical bowel obstruction 

B) non-mechanical bowel obstruction

Answer: A

Gallstones can easily pass through the intestine except at few places such as ileum, the narrowest part of the intestine. It can also occur at the jejunum and stomach. In patients with prior pathology causing strictures such as inflammatory bowel disease, abdominal surgeries, or diverticulitis, it carries a high risk. 

It can also occur after endoscopic sphincterotomy where a large enough stone can cause obstruction. It frequently occurs concurrently with the Mirizzi syndrome (common hepatic duct obstruction due to extrinsic compression from impacted stone in cystic duct). The narrowing of the common hepatic duct can cause cholecystenteric fistula, creating a pathologic exit route for stones. Mirizzi syndrome was first described by Mirizzi more than 70 years ago. 

#surgical-critical-care

References:

1. Mirizzi PL. Syndrome del conducto hepatico. J Int Chir 1948; 8:731. 

2. Halabi WJ, Kang CY, Ketana N, et al. Surgery for gallstone ileus: a nationwide comparison of trends and outcomes. Ann Surg 2014; 259:329. 

3. Ayantunde AA, Agrawal A. Gallstone ileus: diagnosis and management. World J Surg 2007;31:1292. 

4. Beltran MA, Csendes A, Cruces KS. The relationship of Mirizzi syndrome and cholecystoenteric fistula: validation of a modified classification. World J Surg 2008; 32:2237. 

5. Despland M, Clavien PA, Mentha G, Rohner A. Gallstone ileus and bowel perforation after endoscopic sphincterotomy. Am J Gastroenterol 1992; 87:886. 

6. Basili G, Lorenzetti L, Celona G, et al. Gallstone ileus in patient with Crohn's disease: report of a clinical observation. Surg Endosc 2006; 20:703.