An unequivocal preoperative diagnosis of small-intestinal ileus is very often difficult to make, and a positive determination of the etiology of such obstruction is usually impossible. Once a fairly certain diagnosis has been established, it becomes extremely important to discover the source of the trouble without unnecessary delay, for the correct management of the condition may depend upon the identification of the causative agent. Certain mechanical small-bowel obstructions can be treated conservatively, deliberately, and nonsurgically, with complete symptomatic relief, by decompression suction therapy. In most cases of small-intestinal ileus, however, dilatory procedures are contraindicated and procrastination is hazardous.
The delay is particularly dangerous when such ileus is caused by an impacted gallstone, for the mortality rate in cholelithic obstruction has been reported as varying from 30% to 70%, owing, in great part, to the tardiness in diagnosis and treatment.5 Since it is an accepted fact that radiologic examination of
DRUCKER V. Small-Intestinal Gallstone Ileus and Use of Barium Sulfate per Os in Its Diagnosis. AMA Arch Surg. 1959;79(1):22-30. doi:10.1001/archsurg.1959.04320070026004