Gallstone-ileus
(bowelobstruction by a gallstone)
When the passage of the bowel is obstructed, one speaks of ileus. The reason can be a non- functioning of the bowel like for example in peritonitis (inflammation of the membrane covering the abdominal cavity), but also a mechanical cause, such as obstruction in a hernia, in adhesions, inflammation or a tumour. A rare cause is a gallstone that obstructs the bowel. In that case there has generally previously been an inflammation of the gallbladder, with fixed adhesions between the gallbladder and the duodenum (first part of the small bowel). When the inflammation finds its way out from the gallbladder to the duodenum it is possible for a large gallstone to enter the duodenum and to be moved forward further to the rest of the small bowel. The small bowel is the narrowest at the transitionzone to the large bowel. Here the large gallstone gets jammed and the bowel is obstructed: ileus. The only solution is surgical intervention and removal of the gallstone.
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On photograph 1 the puffing-up of the thin bowel is seen well. On photograph 2 contrast fluid has been introduced because prior to operation the diagnosis gallstone-ileus was not clear. A complete obstruction was not seen. (In revising, when after the operation the form of the gallstone was known, the gallstone appeared nevertheless visible as a black clarification beside the white contrast (2)).
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After opening the abdominal cavity the diagnosis became clear. On the transitionzone of the dilated small bowel to normal small bowel a hard swelling in the bowel was felt (3,4). By means of a transverse cut the bowel was opened (5).
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The gallstone came in sight (6) and appeared to exist from several stones which were pressed together to one large stone (7). Hereafter the breach in the bowel was closed and the cause of the ileus had been resolved(8,9).
There can also be other rare causes, for example like an insufficiently chewed orange. In the example mentioned below however, chewing was done to violently as a result of which a part of the artificial teethings demolished, was swallowed and at the transition of the small bowel to the large bowel an obstruction followed! It was taken out through an incision in the large bowel and the patient had an uneventfull recovery.
