Q:

Which of the following statement(s) is/are true concerning gallstone ileus?

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Which of the following statement(s) is/are true concerning gallstone ileus?


  1. The diagnosis may be suggested by plain abdominal radiograph
  2. Primary surgical management consists of relief of obstruction and cholecystectomy
  3. Gallstone ileus accounts for less than 5% of all causes of intestinal obstruction
  4. Typical patients are elderly with long-standing gallstone disease

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a.The diagnosis may be suggested by plain abdominal radiograph

c.Gallstone ileus accounts for less than 5% of all causes of intestinal obstruction

d.Typical patients are elderly with long-standing gallstone disease

Cholecystoenteric fistulas are the most common form of gallbladder perforation accounting for 40% of all cases. Depending on the size of the fistulous communication, a gallstone may pass through this tract. If the stone is large enough (> 2 cm), it may become lodged in a portion of the gastrointestinal tract and cause mechanical small bowel obstruction. This condition, called gallstone ileus, is relatively rare and accounts for fewer than 5% of cases of intestinal obstruction. The diagnosis of gallstone ileus may be suggested by the presence of intrahepatic biliary air in the setting of a small bowel obstruction seen on abdominal radiography. Patients with gallstone ileus are best managed as if they had a mechanical small bowel obstruction with aggressive fluid resuscitation, broad spectrum antibiotics, and early laparotomy. The primary goals at laparotomy are correction of the obstruction and removal of the offending gallstone. Since many of the patients are elderly and ill, cholecystectomy and takedown of the biliary enteric fistula may not be appropriate. Enterolithotomy alone, without cholecystectomy, has an associated mortality of 5% in contrast to 15% mortality rate in patients who undergo both procedures at the same time.

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