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Case Reports
. 2016 Jun;20(6):1278-80.
doi: 10.1007/s11605-016-3096-0. Epub 2016 Feb 8.

The Progression of Cholelithiasis to Gallstone Ileus: Do Large Gallstones Warrant Surgery?

Michael H Freeman  1 , Matthew G Mullen  1 , Charles M Friel  2
Affiliations
Case Reports

The Progression of Cholelithiasis to Gallstone Ileus: Do Large Gallstones Warrant Surgery?

Michael H Freeman et al. J Gastrointest Surg. 2016 Jun.

Abstract

Gallstone ileus is a rare cause of small bowel obstruction, classically occurring in patients with recurrent cholecystitis. The incidence of biliary enteric fistula and gallstone ileus in patients with large, asymptomatic gallstones is not known. We report a case of gallstone ileus, which occurred in the setting of a large, asymptomatic gallstone. This case suggests that large gallstones may warrant cholecystectomy, even in asymptomatic patients.

Keywords: Cholelithiasis; Enterolithotomy; Gallstone ileus.

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Figures

Figure 1
Figure 1
Routine surveillance CT scan demonstrating a large, 4.5cm gallstone abutting the second portion of the duodenum GB (gallbladder); D (duodenum); white arrow (gallstone)
Figure 2
Figure 2
CT scan demonstrating a gas-filled gallbladder, fistulous communication between the gallbladder and duodenum, and gallstone obstructing the proximal ileum 2a: Black arrow (air-filled gallbladder) 2b: White arrow (gallstone obstructing the proximal ileum) 2c: D (duodenum); black arrow (cholecystoduodenal fistula) 2d: S (stomach); D (duodenum); black arrow (cholecystoduodenal fistula); * (dilated loops of small bowel); white arrow (arrow origin at obstructing enterolith showing stone trajectory with downstream decompressed small bowel)
See this image and copyright information in PMC

References

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    1. Halabi WJ, et al. Surgery for gallstone ileus: a nationwide comparison of trends and outcomes. Ann Surg. 2014;259(2):329–35. - PubMed
    1. Csendes A, et al. Number and size of stones in patients with asymptomatic and symptomatic gallstones and gallbladder carcinoma: a prospective study of 592 cases. J Gastrointest Surg. 2000;4(5):481–5. - PubMed

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