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Gallstone Ileus, Emergency Medicine

Joanna W. Davidson Reviewed 06/2017
 


Basics

Description

  • Mechanical intestinal obstruction secondary to impaction of a gallstone within bowel lumen

  • Stone is usually >2.5 cm

  • 1–3% of all intestinal obstructions

  • Most cases occur in patients ...

Diagnosis

Signs and Symptoms

  • “Tumbling” abdominal discomfort:

    • Episodic abdominal pain as stone lodges and dislodges throughout the intestines.

    • Complete impaction leads to severe, often acute abdominal pa...

Treatment

Pre-Hospital

Establish IV access 

Initial Stabilization/Therapy

IV fluid resuscitation 

Ed Treatment/Procedures

  • Nasogastric suction to decompress the stomach and intestine

  • Nothing PO

  • Electrolyte re...

Follow-Up

Disposition

Admission Criteria

  • Admit all patients with gallstone ileus

  • Surgical evaluation for emergent operative intervention

Discharge Criteria

None 

Followup Recommendations

Surgical consultatio...

Pearls and Pitfalls

  • Gallstone ileus is a mechanical intestinal obstruction rather than a true ileus.

  • Emergent surgical consultation is required for definitive management.

  • High mortality rates stem from ...

Additional Reading

  • Bennett  GL, Balthazar  EJ. Ultrasound and CT evaluation of emergent gallbladder pathology. Radiol Clin North Am.  2003;41:1203–1216.

  • Chou  JW, Hsu  CH, Liao  KF, et al. Gallsto...

Codes

ICD9

560.31 Gallstone ileus 

ICD10

K56.3 Gallstone ileus 

SNOMED

  • 37976006 gallstone ileus (disorder)

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