Gallstone ileus

Gallstone ileus is an intestinal obstruction caused by blockage of the intestine after a gallstone enters the biliary tract, first reported by Bartholin in 1654. This disease is clinically rare, with insidious onset, and often presents with intermittent attacks in the early course. Radiographic findings are not typical in every patient, and only 10% to 75% of patients are diagnosed preoperatively. Most obstructions are caused by only one gallstone, but 3% to 15% of patients have multiple stones. Gallstone obstruction can occur at any site of the intestinal tract, but most commonly occurs at the terminal ileum, accounting for 58% to 85%. A large gallstone entering the intestinal lumen first obstructs the more proximal portion of the intestine where the lumen is larger. As the stone gradually descends, the level of obstruction gradually moves downward. The stone can compress the intestinal wall, causing ischemia, increased exudation from the intestinal wall, and excessive fluid accumulation in the proximal dilated loops. Subsequently, the ischemic intestinal wall becomes necrotic and perforates, and intestinal contents leak into the peritoneal cavity, forming diffuse peritonitis.