Robbin's Basic Pathology 8th Edition
Occasionally a large stone may erode directly into an adjacent loop of small bowel, generating intestinal obstruction ("gallstone ileus").
Harrisons's Principles of Internal Medicine 17th Edition
Gallstone ileus refers to mechanical intestinal obstruction resulting from the passage of a large gallstone into the bowel lumen.
The stone customarily enters the duodenum through a cholecystoenteric fistula at that level. The site of obstruction by the impacted gallstone is usually at the ileocecal valve, provided that the more proximal small bowel is of normal caliber. The majority of patients do not give a history of either prior biliary tract symptoms or complaints suggestive of acute cholecystitis or fistulization. Large stones, >2.5 cm in diameter, are thought to predispose to fistula formation by gradual erosion through the gallbladder fundus.
Diagnostic confirmation may occasionally be found on the plain abdominal film (e.g., small-intestinal obstruction with gas in the biliary tree and a calcified, ectopic gallstone) or following an upper gastrointestinal series (cholecystoduodenal fistula with small-bowel obstruction at the ileocecal valve).
Laparotomy with stone extraction (or propulsion into the colon) remains the procedure of choice to relieve obstruction. Evacuation of large stones within the gallbladder should also be performed.
In general, the gallbladder and its attachment to the intestines should be left alone.
p/s: Regarding this matter, me and Jade will discuss this matter directly with Dr Vijay 1st before going up to his superiors. It would be better that we students have to respect our lecturers rite? Will follow up accordingly. Thanks HamSap for the information at the chatbox.
regards
korwoi
