Saturday, March 7, 2015

Study group discussion: Gallstone ileus

*a picture of gall stone ileus was posted in the group as guess the diagnosis after which this discussion took place*

Commonest position of obstruction by gallstone in ileum

Ileocaecal junction?

Not ileocaecal valve. The position in books have been mentioned terminal ileum. A little proximal to the ileocaecal valve.

Most commonly, obstruction occurs at the distal ileum.

I didn't know gallstone ileus could be this big. I imagined them to be tiny!

Me too!

I've heard there has to be a fistula for the stone to be that big to obstruct the ileum. Something that connects the gall bladder to the intestine.. Because a stone this big wouldn't pass the common bile duct

I agree with IkaN

Yup I'm sure the patient suffered from a fistula too..

It enters the intestine through cholecystoduodenal fistula commonly..

I've heard my resident mention fistula once

Yep.. And the predisposed patients are those with Crohn's disease! Thanks, just wanted to confirm it :D

Large stones, >2.5 cm in diameter, are thought to predispose to fistula formation by gradual erosion through the gallbladder fundus...

Ohh that makes sense! The huge stone itself causes fistula formation which is why they are common!

"A fistula develops between a gangrenous gallbladder and the duodenum or other parts of the gastrointestinal tract, allowing passage of the stone. Occasionally the stone may enter the intestine through a fistulous communication between the bile duct and the gastrointestinal tract."

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