GALLSTONE ILEUS

DESCRIPTION :
Obstruction of the small intestine produced by passage of a gallstone from the biliary tract (usual
ly the gallbladder as aresult of cholecystitis) into the intestinal tract (usually by means of a fistulo
us connection between the gallbladder andthe small intestine); occurrence and site of obstruction
depend on size of the stone, but the usual location is at or nearthe ileocecal junction.

In gallstone ileus, gallstones migrate through fistulas and become lodged in the gastrointestinal
tract with the most common site of obstruction in the ileum (60%), followed by the jejunum
(15%), stomach (15%), and colon (5%).

Stones less than 2.5 cm in diameter may traverse the alimentary canal without causing
obstruction. When the gallstone lodges in the duodenum and causes gastric outlet obstruction, it
is called Bouveret's syndrome.

SYMPTOMS

 Abdominal pain is an early sign with vomiting developing later. It tends to become
progressively more severe.
 Abdominal pain is colicky in nature, with freedom from pain between spasms. It is
periumbilical and is not clearly localised.
 Abdominal distension develops.
 Initially the patient may pass stools or flatus but not later.
 Vomiting occurs some hours after the onset of pain and it may be faeculent.

SIGNS

 Patients with gallstones are often, but not invariably, obese.

 The patient tends to look unwell.
 The abdomen may be bloated and small bowel peristalsis may be visible.
 Some slight and nonspecific tenderness of the abdomen is common.
 Auscultation will reveal rushes, gurgling and tinkling sounds at times of pain.
 Features of dehydration will develop.