Gallstone ileus

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Gallstone ileus
Video explanation
SymptomsAbdominal pain, vomiting, constipation, yellowish skin[1]
ComplicationsSepsis, pancreatitis.[1]
Usual onsetAge > 60[1]
CausesObstruction of the bowels by a gallstone[1]
Risk factorsGallstone > 2 cm, recurrent cholecystitis[1]
Diagnostic methodMedical imaging[1]
Differential diagnosisPancreatitis, bile duct stone, peptic ulcer disease, bile duct cancer[1]
Frequency0.4% of people with gallstones[1]

Gallstone ileus is a form of bowel obstruction caused by a gallstone within the gastrointestinal tract.[1] Symptoms may include abdominal pain that come and go, vomiting, and constipation.[1] Less commonly yellowish skin may occur.[1] Complications can include sepsis and pancreatitis.[1]

Risk factors include gallstones larger than 2 cm and recurrent episodes of cholecystitis.[1] The underlying mechanism involves inflammation resulting in the formation of a connection between the gallbladder and gastrointestinal tract through which gallstones can than pass.[1][2] These gallstones can than become stuck, most commonly in the lower part of the ileum.[1] Diagnosis may occur by medical imaging.[1]

Treatment is by surgery.[1] Surgery may involve removing the gallstone, closing the hole between the gallbladder and gastrointestinal tract, and removing the gallbladder.[1] Often only the first part is initial performed with a second surgery if symptoms continue.[1] The risk of death is about 20%.[1]

Gallstone ileus occurs in about 4 in 1,000 people with gallstones.[1] It represents about 2.5% of small bowel obstructions and less than 0.1% of ileuses.[2][3] Women are three times more commonly affected than men.[1] It is more common in those over the age of 60.[1][2] The condition was first described in someone who had died by Thomas Bartholin in 1654.[1][4]

Signs and symptoms

Symptoms may include abdominal pain that come and go, vomiting, and constipation.[1] Less commonly yellowish skin may occur.[1] Complications can include sepsis and pancreatitis.[1]


It is believed to be due to impaction of a gallstone in the gastrointestinal tract after having gone through a biliary-enteric fistula.[5]


Coronal CT image demonstrating gallstone ileus arrow (and stricture in distal ileum).

Diagnosis of gallstone ileus requires radiographic studies. Classic radiographic findings are known as Rigler's triad:[6]


Initial management involves fluid resuscitation and potentially nasogastric suctioning.[7] Since gallstone ileus constitutes a form of mechanical small bowel obstruction, it can be a surgical emergency and requires open or laparoscopic surgery to remove an impacted stone.[7] The different strategies for surgical management are either enterolithotomy alone, allowing a delayed cholecystectomy after an inflammation-free period of 4–6 weeks (and therefore two-stage surgery) or enterolithotomy in combination with a cholecystectomy and fistula division (one-stage surgery). The different strategies for surgical management are controversial, and depend on factors such as patient fitness for surgery and comorbidities.[8]


Bouveret's syndrome refers to reverse gallstone ileus where the gallstone propagates proximally and causes gastric outlet obstruction by being impacted in first part of duodenum.

The name "gallstone ileus" is a misnomer because an ileus is, by definition, a non-mechanical bowel motility failure (as opposed to a mechanical obstruction by a stone).


  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 Turner, AR; Sharma, B; Mukherjee, S (January 2020). "Gallstone Ileus". StatPearls. PMID 28613584.
  2. 2.0 2.1 2.2 Gaillard, Frank. "Gallstone ileus | Radiology Reference Article |". Radiopaedia. Archived from the original on 5 February 2024. Retrieved 9 April 2024.
  3. Inukai, K (2019). "Gallstone ileus: a review". BMJ open gastroenterology. 6 (1): e000344. doi:10.1136/bmjgast-2019-000344. PMID 31875141.
  4. Nuño-Guzmán, CM; Marín-Contreras, ME; Figueroa-Sánchez, M; Corona, JL (27 January 2016). "Gallstone ileus, clinical presentation, diagnostic and treatment approach". World journal of gastrointestinal surgery. 8 (1): 65–76. doi:10.4240/wjgs.v8.i1.65. PMID 26843914.
  5. Turner, Anisha R.; Sharma, Bashar; Mukherjee, Sandeep (2022). "Gallstone Ileus". StatPearls. StatPearls Publishing. Archived from the original on 5 July 2022. Retrieved 19 August 2022.
  6. Ibrahim, Dalia; Gaillard, Frank. "Rigler's Triad". Radiopaedia. Archived from the original on 18 December 2013. Retrieved 17 December 2013.
  7. 7.0 7.1 Longo, DL; Fauci, AS; Kasper, DL; Hauser, SL; Jameson, JL; Loscalzo, J (2015). Harrison's Principles of Internal Medicine (19 ed.). New York: McGraw-Hill. pp. 2081–2082. ISBN 978-0-07-180216-1. Archived from the original on 17 December 2013. Retrieved 3 March 2017.
  8. Fitzgerald J, Fitzgerald L, Maxwell-Armstrong C, Brooks A (2009). "Recurrent gallstone ileus: time to change our surgery?". Journal of Digestive Diseases. 10 (2): 149–151. doi:10.1111/j.1751-2980.2009.00378.x. PMID 19426399.

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