A&P Tip: Gallstone Ileus
Gallstone ileus accounts for only 1-4 percent of all mechanical small bowel obstruction, but increases to 25 percent for patients over 65 years. The common locations for stones are in the distal ileum, followed by the jejunum and gastric outlet.
The clinical course is often subacute and indistinct, with progressive worsening. The initial treatment of gallstone ileus begins with stabilization, correction of electrolyte abnormalities, and surgical exploration. The primary goal is to relieve the obstruction. A decision to perform a cholecystectomy concurrently and a fistula closure is controversial because it increases operative time and the risk of morbidity and mortality. More often, because gallstone ileus occurs most commonly in older, debilitated patients, the length and complexity of the procedure is minimized. In case of recurrence, the fistula closure may be considered along with a cholecystectomy.
Patients presenting with bowel obstruction have many differential diagnoses to consider. The initial workup is directed toward narrowing the lists of potential diagnoses. Lab work and X-rays can help narrow diagnostic options.
Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, is vice president of ICD-10 Training and Education at AAPC.