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Special Feature
July 2003

Image of the Month—Diagnosis

Arch Surg. 2003;138(7):808. doi:10.1001/archsurg.138.7.807

Figure 1. Two large gallstones obstructing the sigmoid colon.

Figure 2. Two large gallstones following transanal extraction.

Gallstone ileus is caused by the erosion of a gallstone (usually >2.5 cm in diameter) into the intestinal lumen via a cholecystenteric fistula (Figure 2). Most commonly, it erodes into the duodenum, but occasionally can erode into the stomach or colon.1

As the gallstone passes down the length of the intestinal tract, it intermittently obstructs the lumen, producing characteristic waxing and waning of symptoms, consistent with small-bowel obstruction. The stone frequently becomes lodged at the ileocecal valve, resulting in complete small-bowel obstruction.1,2