• Gallstones
• Intestinal fistula
• Intestinal obstruction
• Multidetector computed tomography

• acute large bowel obstruction
• acute small bowel obstruction
• gallstone diseases
• gallstone ileus
• rigler's sign

• cholecystoenteric fistula
• enterolithotomy
• exploratory laparotomy
• gallstone ileus
• gallstones
• intestinal obstruction
• karewsky's syndrome
• rigler's triad

• Female
• Humans
• Aged, 80 and over
• Intestinal Obstruction/diagnostic imaging
• Intestinal Obstruction/etiology
• Intestinal Obstruction/therapy
• Ileus/etiology
• Intestine, Small/diagnostic imaging
• Tomography, X-Ray Computed
• Iatrogenic Disease

• cholecystoduodenal
• enterolithotomy
• gallstone
• ileus
• pneumobilia
• rigler’s triad

• abdominal pain
• bowel obstruction
• gallbladder
• gallstone ileus
• surgical approach

• Case report
• Enterolithotomy
• Gallstone ileus
• Intestinal obstruction
• Laparoscopic surgery

Gallstone ileus is a rare form of intestinal obstruction and an uncommon complication of gallstone disease resulting from the impaction of one or more gallstones in the bowel owing to biliary intestinal fistula. The increasing incidence of gallstone ileus is related to the high prevalence of cholelithiasis, the aging of the population, and the more sensitive diagnostic tools. The diagnosis is often delayed due to the lack of typical clinical manifestations. In this paper, we discuss the pathogenesis of gallstone ileus, factors that result in its diagnosis, and therapeutic strategies by performing a systematic review of the literature. We also emphasize the specificity and complexity of gallstone ileus. We suggest that on the basis of observing the basic principles, the management should be rationalized and individualized in clinical practice so as to improve the prognosis of gallstone ileus.

• Intestinal obstruction
• Gallstone ileus
• Diagnosis
• Management

• cholecystectomy
• elderly
• gallstone
• ileus

Gallstone ileus (GSI) is a rare form of small bowel obstruction (SBO) in patients with cholelithiasis, which is often poorly managed. Enhanced abdominal computed tomography (CT) with contrast is considered the most helpful diagnostic tool, as it is highly sensitive, specific, and accurate. We report an interesting case of recurrent GSI that was not detected by CT but diagnosed intraoperatively.

A 49-year-old female with a previous history of choledocholithiasis and ERCP presented to the emergency department following episodes of sudden cramping, epigastric pain, and nausea. An abdominal CT revealed evidence of SBO with clear evidence of GSI and a cholecystoduodenal fistula. Laparoscopic exploration of the small bowel revealed a large, calcified 3.5 cm × 3 cm gallstone with evidence of pressure necrosis; segmental bowel resection with stapled anastomosis was performed and patient recovered appropriately after surgery. Cholecystectomy was not performed due to multiple co-morbidities and absence of gallbladder stones. However, she presented two months later with signs and symptoms of SBO. A repeat abdominal CT showed dilated bowel with no clear transition point. This was suspected to be due to adhesions. After an initial conservative treatment which produced mild improvement, laparotomy was performed which revealed a second large non-calcified gallstone and necrotic small bowel with a pocket of abscess.

The most sensitive diagnostic tool for GSI is enhanced abdominal CT but dilemma arises when GSI is not detected on CT. A high index of suspicion and further exploration are required in order not to miss other vital findings.

• biliary ileus
• diagnosis
• endoscopy
• gallstone
• laparoscopy
• treatment

• Aged
• Aged, 80 and over
• Female
• Gallstones/complications
• Gallstones/diagnosis
• Gallstones/therapy
• Humans
• Ileus/diagnosis
• Ileus/etiology
• Ileus/therapy
• Laparoscopy/methods
• Middle Aged
• Tomography, X-Ray Computed

• Cholecystectomy
• cholecystolithotomy
• gallstone
• ileus
• recurrent

Gallstone ileus (GI) is a mechanical obstruction of small or large bowel caused by gallstone passed to the intestinal lumen through spontaneous or postoperative biliodigestive fistula. A 42-year-old female patient was admitted with the clinical presentation of small bowel obstruction. She underwent hepaticojejunostomy 4 years prior to admission for primary sclerosing cholangitis. Barium meal follows through revealed Rigler's triad. The patient underwent laparotomy which revealed GI. A “stone on a suture” was removed through enterotomy. Patients after cholecystectomy and hepaticojejunostomy can develop GI. Nonabsorbable suture used to create biliodigestive anastomosis can appear to become the frame of a “stone on a suture.”

• Bouveret's syndrome
• enterolithotomy
• gallstone ileus
• hepaticojejunostomy
• small bowel obstruction

Gallstone ileus due to erosion of one or more gallstones into the gastrointestinal tract is an uncommon cause of small bowel obstruction. The site of impaction is usually distal ileum, and less commonly the jejunum, colon, duodenum, or stomach. We report a rare case of gallstone ileus with impaction at the proximal small bowel and at a Meckel’s diverticulum (MD) in a 64-year-old woman managed with laparoscopic converted to open small bowel resections. Patient was discharged home in stable condition and remained asymptomatic at 6-mo follow up. We review the current literature on surgical approaches to MD and gallstone ileus. Diverticulectomy or segmental resection is preferred for complicated MD. For gallstone ileus, simple enterolithotomy or segmental resection are the most the most favored especially in older co-morbid patients due to lower mortality rates and the rarity of recurrent gallstone ileus. In addition, laparoscopy has been increasingly reported as a safe approach to manage gallstone ileus.

• Gallstone ileus
• Meckel’s diverticulum
• Small bowel obstruction
• Laparoscopy
• Cholecystoenteric fistula
• Laparoscopy

Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract. Less than 1% of cases of intestinal obstruction are derived from this etiology. The symptoms and signs of gallstone ileus are mostly nonspecific. This entity has been observed with a higher frequency among the elderly, the majority of which have concomitant medical illness. Cardiovascular, pulmonary, and metabolic diseases should be considered as they may affect the prognosis. Surgical relief of gastrointestinal obstruction remains the mainstay of operative treatment. The current surgical procedures are: (1) simple enterolithotomy; (2) enterolithotomy, cholecystectomy and fistula closure (one-stage procedure); and (3) enterolithotomy with cholecystectomy performed later (two-stage procedure). Bowel resection is necessary in certain cases after enterolithotomy is performed. Large prospective laparoscopic and endoscopic trials are expected.

• Intestinal obstruction
• Bouveret’s syndrome
• Laparoscopic surgery
• Endoscopic treatment
• Gallstone ileus

An 85-year-old woman was an outpatient treated at Tokyo Rosai Hospital for cirrhosis caused by hepatitis B. She had previously been diagnosed as having common bile duct stones, for which she underwent endoscopic retrograde cholangiopancreatography (ERCP). However, as stone removal was unsuccessful, a plastic stent was placed after endoscopic sphincterotomy. In October 2012, the stent was replaced endoscopically because she developed cholangitis due to stent occlusion. Seven days later, we performed ERCP to treat recurring cholangitis. During the procedure, the stone was successfully removed by a balloon catheter when cleaning the common bile duct. The next day, the patient developed abdominal pain, abdominal distension, and nausea and was diagnosed as having gallstone ileus based on abdominal computed tomography (CT) and abdominal ultrasonography findings of an incarcerated stone in the terminal ileum. Although colonoscopy was performed after inserting an ileus tube, no stone was visible. Subsequent CT imaging verified the disappearance of the incarcerated stone from the ileum, suggesting that the stone had been evacuated naturally via the transanal route. Although it is extremely rare for gallstone ileus to develop as a complication of ERCP, physicians should be aware of gallstone ileus and follow patients carefully, especially after removing huge stones.

• Bezoar
• Biliary fistulas
• Cholecystogastric fistula

• Gallstone ileus
• pneumobilia
• rigler's triad
• small bowel obstruction

• Abdomen agudo
• Acute abdomen
• Gallstone ileus
• Intestinal obstruction
• Obstrucción intestinal
• Íleo biliar

Gallstone ileus (GI) is characterized by occlusion of the intestinal lumen as a result of one or more gallstones. GI is a rare complication of gallstones that occurs in 1%-4% of all cases of bowel obstruction. The mortality associated with GI ranges between 12% and 27%. Classical findings on plain abdominal radiography include: (1) pneumobilia; (2) intestinal obstruction; (3) an aberrantly located gallstone; and (4) change of location of a previously observed stone. The optimal management of acute GI is controversial and can be: (1) enterotomy with stone extraction alone; (2) enterotomy, stone extraction, cholecystectomy and fistula closure; (3) bowel resection alone; and (4) bowel resection with fistula closure. We describe a case to highlight some of the pertinent issues involved in GI management, and propose a scheme to minimize recurrent disease and postoperative complications. We conclude that GI is a rare condition affecting mainly the older population with a female predominance. The advent of computed tomography and magnetic resonance imaging has made it easier to diagnose GI. Enterotomy with stone extraction alone remains the most common surgical method because of its low incidence of complications.

• Gallstone ileus
• Fistula closure
• Intestinal obstruction
• Bowel obstruction
• Enterolithotomy

• Female
• Gallstones/complications
• Gallstones/surgery
• Humans
• Ileus/etiology
• Ileus/surgery
• Middle Aged

Gallstone ileus, an uncommon complication of cholelithiasis, is described as a mechanical intestinal obstruction due to impaction of one or more large gallstones within the gastrointestinal tract. The clinical presentation is variable, depending on the site of obstruction, manifested as acute, intermittent or chronic episodes. A 51-year-old female patient was referred to our hospital with 3 events of intestinal obstruction during the previous 7 d. At admission, there were clinical signs of intestinal obstruction; abdominal film demonstrated dilated bowel loops, air-fluid levels and a vague image of a stone in the inferior left quadrant. Once stabilized, a laparotomy was performed. Surgical findings were distention of the jejunum and ileum proximal to a palpable stone in the ileum as well as gallstones and a cholecystoduodenal fistula in the gallbladder. An enterolithotomy, repair of the cholecystoduodenal fistula and cholecystectomy were performed. The postoperative course was uneventful. There is no uniform surgical procedure for this disease. When the patient is too ill or when biliary surgery is not advisable, an enterolithotomy is the best option. The one-stage procedure should be the offered to adequately stabilized patients when local and general conditions, such as good cardiorespiratory and metabolic reserve permit a more prolonged surgical procedure.

• Gallstone ileus
• Cholecystoduodenal fistula
• Intestinal obstruction

Gallstone ileus is a mechanical obstruction caused by the impaction of one or more gallstones within the lumen of any part of the gastrointestinal tract. Although the disorder is a rare cause of small bowel obstruction (1% to 2%), it has been reported to cause up to 25% of cases of non-strangulated small bowel obstruction in patients over 65 years of age.

We report a case of a 67-year-old woman who presented with gallstone ileus following endoscopic retrograde cholangiopancreatography and sphincterotomy for choledocholithiasis. She had a history of terminal ileum resection with ileocolic anastomosis for Crohn's disease. A 3 cm gallstone was found to be impacted just proximal to the previous ileocolic anastomosis. A second gallstone was found on digital examination of the proximal small bowel.

A gallstone may enter the gastrointestinal tract following endoscopic retrograde cholangiopancreatography and sphincterotomy and impact proximal to an anastomotic stricture as demonstrated here. The radiographic image of small bowel obstruction plus air in the biliary tree is a classic diagnostic finding. After stone extraction, the entire small bowel and colon should be digitally examined for further stones.

• Aged
• Fluid Therapy
• Gallstones/diagnostic imaging
• Gallstones/therapy
• Humans
• Ileus/diagnostic imaging
• Ileus/therapy
• Male
• Tomography, X-Ray Computed

• Aged
• Aged, 80 and over
• Biliary Fistula/diagnosis
• Biliary Fistula/surgery
• Cholangitis/etiology
• Cholangitis/mortality
• Cholecystectomy
• Female
• Follow-Up Studies
• Gallstones/diagnosis
• Gallstones/surgery
• Humans
• Ileal Diseases/diagnosis
• Ileal Diseases/surgery
• Ileus/diagnosis
• Ileus/surgery
• Jejunal Diseases/diagnosis
• Jejunal Diseases/surgery
• Male
• Middle Aged
• Postoperative Complications/etiology
• Postoperative Complications/mortality
• Retrospective Studies
• Survival Rate
• Tomography, X-Ray Computed
• Ultrasonography

Gallstone ileus is a rare disease and accounts for 1%-4% of all cases of mechanical intestinal obstruction. It usually occurs in the elderly with a female predominance and may result in a high mortality rate. Its diagnosis is difficult and early diagnosis could reduce the mortality. Surgery remains the mainstay of treatment. We report two cases of gallstone ileus. The first was a 78-year old woman who had a 2-d history of vomiting and epigastralgia. Plain abdominal film suggested small bowel obstruction clinically attributed to adhesions. Later on, gallstone ileus was diagnosed by abdominal computed tomography (CT) based on the presence of pneumobilia, bowel obstruction, and an ectopic stone within the jejunum. She underwent emergent laparotomy with a one-stage procedure of enterolithotomy, cholecystectomy and fistula repair. The second case was a 76-year old man with a 1-wk history of epigastralgia. Plain abdominal film showed two round calcified stones in the right upper quadrant. Fistulography confirmed the presence of a cholecystoduodenal fistula and gallstone ileus was also diagnosed by abdominal CT. We attempted to remove the stones endoscopically, but failed leading to an emergent laparotomy and the same one-stage procedure as for the first case. The postoperative courses of the two cases were uneventful. Inspired by these 2 cases we reviewed the literature on the cause, diagnosis and treatment of gallstone ileus.

• Gallstone ileus
• Intestinal obstruction
• Pneumobilia
• One-stage procedure
• Enterolithotomy
• Cholecystoduodenal fistula

• Aged
• Female
• Gallstones/complications
• Gallstones/diagnosis
• Humans
• Ileus/diagnosis
• Ileus/etiology
• Male

• Adult
• Aged
• Aged, 80 and over
• Female
• Gallstones/complications
• Gallstones/surgery
• Humans
• Ileus/etiology
• Ileus/surgery
• Laparoscopy/methods
• Length of Stay
• Male
• Middle Aged
• Postoperative Complications/etiology
• Retrospective Studies
• Treatment Outcome

• Cholelithiasis/complications
• Cholelithiasis/diagnosis
• Diagnosis, Differential
• Duodenal Obstruction/diagnosis
• Duodenal Obstruction/etiology
• Endoscopy, Gastrointestinal
• Gastric Outlet Obstruction/diagnosis
• Gastric Outlet Obstruction/etiology
• Humans
• Syndrome
• Tomography, X-Ray Computed