Complications of gallstones

Gallstone ileus

• Mechanical obstruction (often at the ileocaecal valve) due to passage of a large gallstone (> 2.5 cm) through a cholecystoduodenal fistula.

Signs and symptoms

• Abdominal pain, vomiting, absolute constipation (signs of small bowel obstruction)
• Patient may or may not have a history of biliary colic

Investigation

• Abdominal X-ray: SBO and pneumobilia (gas in the biliary tree)
• Upper GI barium contrast images will demonstrate no contrast in the colon (obstruction at ileocaecal valve)

Treatment

• Laparotomy with stone extraction, closure of the fistula and cholecystectomy

Mirizzi Syndrome

• Common hepatic duct obstruction caused by extrinsic compression from the impacted stone in the cystic duct or gallbladder neck/infundibulum

Signs and Symptoms

• Jaundice, fever and RUQ pain

Investigations

• Bloods: raised alkaline phosphatase, Gamma GT and bilirubin
• Imaging (abdominal ultrasound, contrast-enhanced CT and/or MRCP) showing:
  • Dilatation of the biliary system proximal to obstruction site
  • Presence of a stone in the gallbladder neck/cystic duct
  • An abrupt change to a normal diameter of the common duct below the level of obstruction

Management

• Surgery
• Endoscopic treatment can be effective in select patients or those who are no a surgical candidate

Reference: UpToDate