A&P Tip: Gallstone Ileus

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.

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Rhonda Buckholtz

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Rhonda Buckholtz, CPC, CPMA, CRC, CDEO, CMPE, CHC, COPC, AAPC Approved Instructor, is owner of Coding and Reimbursement Experts. She spends her time helping physician practices achieve operational excellence, compliance, education, and Lean Six Sigma through her consulting. Buckholtz has more than 30 years of experience in healthcare management, compliance, and reimbursement/coding sectors. She was responsible for all ICD-10 training and curriculum at AAPC during the transition from ICD-9. Buckholtz has authored numerous articles for healthcare publications and she has spoken at numerous national conferences for AAPC and others. She is past co-chair for the WEDI ICD-10 Implementation Workgroup, Advanced Payment Models Workgroup, and she provided testimony for ICD-10 and standardization of data for National Committee on Vital and Health Statistics. Buckholtz is on AAPC’s National Advisory Board.

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