Gallstone Ileus: Causes, Symptoms & Treatment

Gallstone ileus refers to a rare complication in gallstone disease in which a gallstone dislodged from the bile ducts causes an intestinal obstruction. A gallstone underlies about three percent of all intestinal obstructions. Gallstone ileus most commonly occurs in older patients.

What is gallstone ileus?

In technical terms, intestinal obstruction is called ileus. It represents a complete interruption of the usual intestinal passage of the small and large intestines. A noncomplete obstruction is called a subileus. The term ileus comes from the Greek and translates into German as inclusion or union. If the intestinal tract is closed or obstructed in its passage, ingested food and fluid can no longer be transported. The contents of the intestine build up. If intestinal obstruction is caused by a gallstone, it is gallstone ileus.

Causes

Gallstone disease often triggers inflammation that is not limited to the gallbladder alone. Rather, they also spread to the intestine, whose delicate mucosa is destroyed in the process. The gallbladder then either bursts through into the abdominal cavity or perforates the colon. This results in the formation of a fistula, which is referred to as cholecystocolic or cholecystoduodenal. In chronic disease progression, a condition called aerobilis often forms, with air trapped in the bile ducts. Chronic diarrhea and deficiency of vitamin K occur during the course of the disease. Gallstone ileus forms when a larger gallstone migrates into the intestine via the resulting fistula. The intestinal obstruction is then found in the fistula area or between the small and large intestines.

Symptoms, complaints, and signs

Intestinal obstruction, or ileus, causes different symptoms depending on the underlying cause of the condition. A distinction is generally made between mechanical and functional bowel obstruction. Mechanical ileus often causes severe abdominal pain, vomiting, gas accumulation in the bowel, and retention of stool. If mechanical obstruction develops, the symptoms show a highly active bowel as it strives to push its contents through the narrowed passage. This excessive activity of the bowel is referred to in technical language as hyperperistalsis. The attending physician uses a stethoscope to listen to the abdomen. The stethoscope then makes clear splashing and whistling noises. If the gallstone ileus is already so far advanced, the affected person suffers from colicky pain. A hard and stiff intestine can be palpated via the abdomen.

Diagnosis and course

The symptoms of intestinal obstruction vary greatly in severity and depend on the location of the narrowed passage. However, it can be quickly distinguished whether the small or large intestine is affected. The physician recognizes the mechanical obstruction by the frequently occurring symptoms such as gas accumulation, lack of bowel movement, flatulence and vomiting. The deeper obstruction in the small intestine does not initially cause vomiting. This only occurs in the advanced stages and shows a striking brown coloration with a foul odor. In both cases, patients suffer from severe abdominal pain, usually in the abdominal region. So-called functional paralytic ileus presents with symptoms such as pain, belching, vomiting and nausea. If the physician listens to the abdomen, he or she does not hear any bowel sounds, in contrast to mechanical obstruction. When functional paralytic bowel obstruction develops, the abdominal area is not initially indurated. There is increased gas accumulation. If inflammation of the peritoneum occurs in this disease, the typical symptoms also change. The so-called drum belly appears, which tightens and hardens.

Complications

In most cases, gallstone ileus is associated with very unpleasant discomfort and symptoms. In this case, most patients suffer from severe vomiting and severe pain in the stomach and intestines. There is also gas accumulation in the intestine, which is associated with flatulence. The quality of life of the affected person is considerably reduced by gallstone ileus. It also leads to a so-called intestinal obstruction, which must be treated urgently by a doctor.Those affected not infrequently suffer from vomiting and dizziness. They may also experience belching. Due to the persistent pain and discomfort, it is not uncommon for psychological complaints or depression to occur. Those affected not infrequently withdraw from life and no longer actively participate in everyday life. The treatment of gallstone ileus is usually carried out with the help of medication and surgical interventions Complications do not occur. In most cases, the symptoms disappear after a short time after treatment and do not continue to occur. However, the cause of the bowel obstruction is usually still treated afterwards.

When should you go to the doctor?

If the affected person suffers from abdominal pain and nausea, a doctor should be consulted as soon as the complaints persist for several days or occur repeatedly. If the pain spreads further into the abdomen, the family doctor should be consulted. If flatulence, unpleasant belching or a feeling of fullness in the body occurs repeatedly, a doctor is needed for further examinations. If the complaints increase in intensity or additional symptoms occur, a doctor should be consulted. If there is a fever, a feeling of illness or general malaise, a doctor should be consulted for clarification of the irregularities. Persistent constipation despite adequate fluid intake or undesirable problems with bowel movements must be investigated and treated. In case of cramp-like discomfort in the upper abdomen, general physical weakness and reduced performance, a visit to the doctor is necessary to find out the causes. If the affected person can no longer carry out everyday duties as usual, he or she should seek the help and support of a physician. Chronic diarrhea, a persistent inner restlessness and changes in the respiratory system should be subjected to medical treatment. If the affected person can feel hardenings in the area of the gastrointestinal tract with his fingers, this observation should be discussed with a physician. Tightness that is not self-regulated is considered unusual and should be investigated.

Treatment and therapy

Therapy for gallstone ileus is often started with placement of a gastric tube. Initially, the cause of the obstruction does not matter. Through the tube of the gastric tube, the treating physician has the opportunity to remove the stomach contents and thus help relieve the bowel. Infusions are also a standard measure in the presence of gallstone ileus. The aim is to ensure that all electrolytes and fluids lost through the intestines are replaced. A bladder catheter is placed so that the physician can keep track of fluids absorbed and lost. It is also common to administer pain-relieving medications to the patient to relieve the discomfort associated with bowel obstruction, such as pain, vomiting and nausea. If the intestinal muscles are paralyzed by the ileus, these noninvasive interventions may initially be sufficient. However, if there is a so-called strangulated obstruction, which is an interruption of the blood supply to the intestine due to vascular strangulation, further medication should be considered. This restarts the motor function of the intestine, which has come to a standstill, by stimulating peristalsis again. It is not uncommon, however, for invasive surgery to be required in this case.

Outlook and prognosis

Gallstone ileus generally has a good prognosis. If no other diseases are present and the affected person has a healthy immune system, complete recovery is possible within a few weeks. Diagnosis and therapy of the causative disorder is required for this, although initial medical care via a gastric tube will provide relief from the current symptoms. The functional activity of the intestine is restored and monitored in further therapy. In order to avoid further complications, it is necessary to provide the organism with sufficient fluids during the entire treatment period. If the patient was also found to have irregularity of blood supply in the intestine, further medicinal steps are indicated. In a large number of cases, gallstone ileus occurs in elderly people. They often have other diseases and their endogenous immune system is often naturally weakened. As a result, the healing process may be significantly delayed.Post-treatment wound care is delayed and can lead to complications. The patient’s quality of life is reduced. Nevertheless, in normal cases, a gallstone ileus is not expected to shorten the patient’s life. Psychological impairment may occur and recurrence of symptoms is possible. In principle, the overall state of health must be taken into account when considering the prospect of complete freedom from symptoms.

Prevention

Gallstone ileus can basically only be partially prevented. Basically, care should be taken to prevent gallstone formation. An important aspect in the prevention of intestinal obstruction is regular bowel movements. But diet also plays a significant role. In any case, food that is difficult to digest, especially from personal experience, should be avoided, as this can also cause gallstones to form. Intestinal obstructions also frequently occur after abdominal surgery. These are then referred to as postoperative ileus. For this reason, it is important to pay particular attention to typical symptoms such as pain, vomiting, gas accumulation and lack of bowel movement after such operations. If these occur, a physician should be consulted immediately.

What you can do yourself

Gallstone ileus is a life-threatening condition that requires immediate surgical treatment. If gallstone ileus is not operated on promptly, the patient will die from it. However, the occurrence of gallstone ileus is extremely rare. It also cannot be diagnosed by the patient himself; diagnosis is possible only through an imaging procedure. Gallstone ileus is by no means the consequence of untreated gallstones, but only a very rare form of secondary disease. If an educated and informed patient suspects the possibility of gallstone ileus in himself, a physician or the hospital should be consulted immediately. After a successful operation and the patient’s reintegration into everyday life – usually after completing an appropriate rehabilitation measure – there are, however, ways in which the patient can actively support and promote his or her healing and recovery. Here it depends on a balanced organization of the everyday life: Activity and sufficient rest periods should be balanced. Light physical activity, such as walking in the fresh air, has a positive effect on the cardiovascular system, general well-being and fitness. In this way, the body can be strengthened and recover from the operation. Adhering to the diet prescribed by a doctor and abstaining from alcohol are also important.