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Gallstone Ileus

Gallstone Ileus

In gallstone ileus, the ileum is blocked by presence of one or more gallstones. Diagnosed mostly in elderly patients, this ileum obstruction by gallstones is a medical emergency, which requires surgical intervention for treatment.
Ningthoujam Sandhyarani
The stone or pebble like, small size material present in the gallbladder is known as gallstone. As we all are aware, the gallbladder does the main functions of storing bile juice (produced by the liver) and releasing it to the bile ducts, whenever required. The bile juice contains fats, cholesterol, proteins, bilirubin and salts. In case, the concentration of bilirubin and fatty substances is elevated, bile juice gets hardened and forms small stone like materials. Gallstone ileus is a rare complication that calls for immediate therapeutic intervention.

Development of gallstones is not an unusual condition in medical science. Nonetheless, gallstone ileus is a special case, which is accompanied with bowel obstruction symptoms. So, actually what do you mean by gallstone ileus? It is a medical complication, in which one or more gallstones lodge in the ileum portion and prevent partly digested food particles from passing to the lower intestinal tract. As per medical reports, gallstone lodging in the ileum contributes to mechanical bowel obstruction problems by about 1-4%.

Being overweight or obese and having a family history of gallstones are major risk factors of gallstone ileus. Females are prone to developing gallstones. The patients afflicted with this intestinal blockage problems belong to geriatric group, especially amongst those who have underlying diseases and disorders. To be more precise, elderly people who have been diagnosed with high blood pressure, liver disorder and diabetes, etc. are at a higher risk of developing this intestinal obstruction than others. As expected, clinical signs of gallstone lodging in the ileum differ slightly from one patient to another.

Symptoms
The concerning issue with gallstone obstruction in the ileum is, the symptoms are vague and occur intermittently in most instances. Hence, diagnosis of the same is usually done while conducting X-ray imaging tests for other medical problems. In the initial stages, afflicted people generally feel unwell without clear symptoms. They may experience excess gas buildup in the gastrointestinal tract, accompanied with painful signs. Listed below are some of the abdominal symptoms that signify gallstone ileus.
  • Recurring bouts of abdominal pain
  • Nauseated feeling and vomiting
  • Swelling and tenderness in the abdominal area
  • Excessive gassiness and bloating
  • Difficulty in bowel movement
  • Dehydration effect
Treatment
Presence of fistula close to the gallbladder triggers this bowel obstruction. This makes a path for gallstones to enter the intestine and block the ileum. In case abdominal pain and vomiting are exhibited for a maximum of 3 consecutive days, one should visit a health care setting for correct diagnosis. The doctor may perform a regular X-ray imaging test in combination with computed tomography (CT) scan and ultrasonography of the abdomen for diagnosing gallstone ileus and other medical conditions that mimic the reported symptoms.

Once gallstone blockage of the ileus is confirmed, the doctor will discuss appropriate treatment options with the patient. Failure to undergo the treatment promptly increases the chances of bowel rupture, which in turn is associated with internal bleeding, leakage of intestinal contents and spreading of infection. While there are various approaches for management of gallstone ileus, the only reliable treatment option is surgical removal of the obstructing material. There are two types of surgeries for gallstone ileus intervention, the one-stage procedure for relatively healthy patients and two-stage procedure for risky patients.

In the one-stage surgery option, three different procedures are conducted simultaneously - first is enterolithotomy (cutting the border of the bowel longitudinally to remove gallstones), followed by cholecystectomy (gallbladder removal) and fistula repair (closing of the fistula). On the other hand, enterolithotomy or cholecystectomy is conducted alone in the first stage of a two-stage procedure treatment. After this, the second stage involving fistula repair is performed. Candidates who have participated in any of the two gallstone surgery procedures should go for regular follow-up visits to minimize cholangitis and similar postoperative complications.

Unfortunately, the prognosis of gallstone ileus is not good for most patients. This is mainly because of intermittent symptoms leading to delayed diagnosis and treatment. If diagnosis is done in the early stages, a good prognosis can be expected for the patients. Regarding prevention of gallstone ileus, the objective is to avoid factors that contribute to gallstone formation. Thus, preventive measures include controlling weight and including low-fat and high fiber foods in the diet plan.