Obstruction of the alimentary tract from gallstones

Abstract

1. 1. In a consecutive series of 130 cases of acute intestinal obstruction gallstones were responsible in four cases. 2. 2. During the same period of observation a fifth case with intermittent pyloric obstruction from a large intragastric gallstone was encountered. 3. 3. There is an antecedent history of gall-bladder disease in about 50 per cent of the cases. 4. 4. The usual clinical picture is that of an elderly, obese female patient with intermittent partial intestinal obstruction, ultimately becoming complete. 5. 5. A preoperative diagnosis of the type of obstruction is rarely made. The stones are rarely radiopaque and x-ray assists only through demonstrating intestinal obstruction with occasionally the presence of air or barium in the extrahepatic biliary system. 6. 6. The recorded mortality in the group of cases is unduly high, being the result of the age and obesity of the patients, delayed diagnosis and too extensive surgery. 7. 7. In our five reported cases there was no mortality, obstructing stones being successfully removed from the ileum in three instances, the sigmoid in one and the stomach in one. 8. 8. Gallstone obstruction should be suspected in elderly obese patients with a previous history of gallbladder disease who develop a picture of progressive partial intestinal obstruction.