A 78-year-old woman presents with small bowel obstruction. Plain X-ray shows air in the biliary tree (pneumobilia) and a calcified mass in the right iliac fossa. A gallstone is seen in the jejunum on CT. What is the definitive management?

• A Endoscopic retrieval via ERCP
• B Laparoscopic cholecystectomy alone
• C Laparotomy with enterolithotomy and stone extraction ✓
• D Extracorporeal shock wave lithotrization followed by observation

Explanation

Gallstone ileus is a mechanical small bowel obstruction caused by a gallstone that has entered the intestinal tract via a cholecystoenteric fistula. Rigler triad (pneumobilia, ectopic gallstone, small bowel obstruction) is characteristic. Definitive management is laparotomy with enterolithotomy to remove the obstructing stone. One-stage procedure (stone removal plus cholecystectomy and fistula closure) is reserved for low-risk patients.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.