Assessment of Gallstone ileus: Video, Anatomy, Definition & Function | Osmosis

Question

A 72-year-old woman comes to the emergency department because of intermittent crampy abdominal pain associated with nausea and vomiting for the last five days. She had an episode of vomiting with hematemesis six hours ago. Past medical history is significant for diabetes mellitus, gallstones, and hypertension. Current medications are metformin and lisinopril. Temperature is 38.2°C (100.8°F), pulse is 118/min, respirations are 22/min, and blood pressure is 110/60 mm Hg. Abdominal examination shows distention and tenderness, and hyperactive high-pitched bowel sounds are heard on auscultation. An abdominal radiograph shows pneumobilia and dilated loops of small bowel. Laboratory results are shown below:

Laboratory value	Result
Leukocyte count	23,250/mm3
Hemoglobin	12 g/dL
Hematocrit	46%
Platelets	400,000/µL
Lipase	140 U/L
AST, SGOT	47 U/L
ALT, SGPT	45 U/L
Total bilirubin	0.8 mg/dL

Which of the following is the most likely underlying cause of this patient's presentation?

Accepted Answer

Mechanical bowel obstruction

Answer

Emphysematous cholecystitis

Answer

Superior mesenteric artery syndrome

Answer

Colonic pseudo-obstruction

Answer

Diverticulitis&#160;

Answer

Acute hepatitis&#160;

Questions or feedback?

Gallstone ileus

Pathology

Gastrointestinal system