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Gallstone ileus

Andrew P Keaveny, MD, FRCPI
Nezam H Afdhal, MD, FRCPI
Steven Bowers, MD
Section Editors
Stanley W Ashley, MD
Sanjiv Chopra, MD, MACP
Deputy Editor
Wenliang Chen, MD, PhD


Gallstone ileus is an important, though infrequent, cause of mechanical bowel obstruction, affecting older adult patients who often have other significant medical conditions. It is caused by impaction of a gallstone in the ileum after being passed through a biliary-enteric fistula. The diagnosis is often delayed since symptoms may be intermittent and investigations fail to identify the cause of the obstruction. The mainstay of treatment is removal of the obstructing stone after resuscitating the patient. Gallstone ileus continues to be associated with relatively high rates of morbidity and mortality.

Other causes of intestinal obstruction are discussed elsewhere. (See "Epidemiology, clinical features, and diagnosis of mechanical small bowel obstruction in adults".)


Gallstone ileus is an unusual complication of cholelithiasis, occurring in less than 0.5 percent of patients who present with mechanical small bowel obstruction [1]. Female and older patients are disproportionally affected [1,2].


The usual means of gallstone entry into the bowel is through a biliary enteric fistula, which complicates 2 to 3 percent of all cases of cholelithiasis with associated episodes of cholecystitis. Sixty percent are cholecystoduodenal fistulas, but cholecystocolonic and cholecystogastric fistulas can also result in gallstone ileus [3]. (See "Acute cholecystitis: Pathogenesis, clinical features, and diagnosis".)

The Mirizzi syndrome refers to common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct. An association between the Mirizzi syndrome and the presence of a cholecystoenteric fistula has been suggested because when a stone is impacted in the cystic duct it can result in narrowing of the common hepatic duct, which can lead to a cholecystenteric fistula thus providing an exit route for gallstones [4].

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Literature review current through: Nov 2017. | This topic last updated: Jun 05, 2017.
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