Gallstone Obstruction Diagnosis and Management
Summary
Gallstone obstruction encompasses a spectrum of clinical entities arising when cholesterol or pigment calculi migrate from the biliary tract and impede gastrointestinal flow. The most common presentation is gallstone ileus, in which large stones enter the intestinal lumen via a fistula and obstruct the small bowel. A rarer variant is Bouveret’s syndrome, marked by gastric outlet obstruction following impaction of a gallstone in the proximal duodenum or stomach. Diagnosis relies on a combination of careful clinical assessment, laboratory tests indicating inflammation or cholestasis, and imaging modalities. Ultrasonography can suggest biliary pathology but is often limited in detecting ectopic stones. Contrast-enhanced computed tomography (CT) has emerged as the gold standard for visualising obstructing calculi, fistulous tracts and secondary complications. Endoscopic techniques permit both diagnosis and, in selected cases, non-surgical stone retrieval or fragmentation. Management strategies range from minimally invasive endoscopy and laparoscopy to open surgery, with decisions guided by stone location, patient comorbidities and intra-abdominal findings. A tailored approach that balances urgent relief of obstruction against the risks of definitive biliary surgery has been shown to reduce morbidity and mortality across diverse patient populations.
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Gallstone Obstruction Diagnosis and Management publication trend
The graph below shows the total number of articles in gallstone obstruction diagnosis and management across all publications each year (not limited to Nature Index journals).
Technical terms
Gallstone ileus: Mechanical small bowel obstruction caused by a gallstone that has passed into the intestine via a biliary-enteric fistula.
Bouveret’s syndrome: Gastric outlet obstruction due to impaction of a gallstone in the proximal duodenum or stomach.
Enterolithotomy: Surgical removal of an obstructing intestinal stone through a small bowel incision.
Electrohydraulic lithotripsy: Endoscopic fragmentation of calculi using high-frequency electrical pulses transmitted through a fluid medium.
References
- Clinical and radiological diagnosis of gallstone ileus: a mini review. Emergency Radiology (2017).
- Bouveret's Syndrome: Literature Review. Cureus (2018).
- Gallstone Ileus: Management and Clinical Outcomes. Medicina (2019).
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