Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ Gallstone Ileus + • Small bowel obstruction secondary to 1 or more large gallstones entering via cholecystoduodenal fistula +++ Mirizzi Syndrome + • Biliary stricture secondary to direct compression by chronically impacted cystic duct gallstone or chronic inflammation secondary to chronically inflamed gallbladder +++ Epidemiology + • Both gallstone ileus and Mirizzi syndrome are rare complications mainly affecting patients older than 60 years +++ Symptoms and Signs +++ Gallstone Ileus + • Signs and symptoms of small bowel obstruction and possible antecedent history of biliary colic +++ Mirizzi Syndrome + • Chronic or history of right upper quadrant pain along with jaundice +++ Laboratory Findings +++ Gallstone Ileus + • Hypokalemia• Prerenal azotemia• Hypernatremia• Leukocytosis +++ Mirizzi Syndrome + • Hyperbilirubinemia• Elevated alkaline phosphatase +++ Imaging Findings +++ Gallstone Ileus + • Abdominal x-ray-Air-fluid levels-Dilated loops of small bowel-Possible pneumobilia• US-Cholelithiasis and pneumobilia• Hypaque swallow-Fistula between duodenum and gallbladder +++ Mirizzi Syndrome + • US-Biliary dilatation (> 6 mm)-Cholelithiasis-Possible thickened wall of gallbladder• ERCP or percutaneous transhepatic cholangiogram (PTC)-Stricture of common bile duct +++ Gallstone Ileus + • Overall clinical status of patient +++ Mirizzi Syndrome + • Evaluate for malignant causes of stricture +++ Gallstone Ileus + • History and physical exam• CBC• Electrolytes• Blood urea nitrogen, creatinine• Plain abdominal x-ray• Right upper quadrant US• Small bowel contrast study if partial small bowel obstruction +++ Mirizzi Syndrome + • History and physical exam• CBC• Liver function tests• Right upper quadrant US +++ Surgery +++ Gallstone Ileus + • Removal of retained small bowel gallstone(s) via enterostomy or partial resection if bowel damaged• Cholecystectomy and resection of fistula and duodenal closure at same operation or as staged procedure +++ Mirizzi Syndrome + • Cholecystectomy and resection and/or bypass of stricture via hepaticojejunostomy +++ Contraindications + • Clinical status of patient during laparotomy for gallstone ileus +++ Complications +++ Gallstone Ileus + • Missed enteral gallstone and recurrent obstruction• Duodenal leak• Bile duct injury or leak +++ Mirizzi Syndrome + • Anastomotic leak or stricture• Cholangitis +++ References ++Glasgow RE et al: The spectrum and cost of complicated gallstone disease in California. Arch Surg 2000;135:1021.... GET ACCESS TO THIS RESOURCE Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessSurgery 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessSurgery Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options