0:00

Okay, so here is the classic KUB of gallstone

0:04

ileus and our patient in the right upper quadrant.

0:07

You can faintly see the pneumobilia outlining

0:09

the common bile duct and into the liver,

0:11

and you see dilated loops of small bowel.

0:13

Once in a while you'll get a calcified

0:15

gallstone, and then you've like.

0:16

Hit it outta the park.

0:17

But this is a beautiful KUB of gallstone ileus.

0:20

Not that I'm expecting you to make the diagnosis

0:22

from this, but you know, someday you wanna be a hero.

0:24

So let's go with it again.

0:26

Gallstone ileus should be called gallstone

0:27

obstruction, but I can't change things in medicine.

0:30

There are a lot of things I'm trying

0:31

to change, and no one will let me.

0:32

So, um, we're just gonna call it gallstone.

0:34

Ileus, 'cause that's what people know.

0:36

Here's the birth of our gallstone,

0:37

isn't it so cute, so lucky.

0:40

Sometimes you'll even get the

0:41

surgical pictures back from these.

0:42

Here's a beautiful gallstone ileus with an

0:44

enlarged thickened gallbladder with a large

0:47

calcified gallstone in the small bowel.

0:49

Again, birth of a gallstone.

0:50

Everyone's so happy, um, that these do need to be taken

0:53

for surgical mies and for birth of those gallstones.

0:57

They can obstruct in weird ways as well.

0:59

Here was a case where the patient had had a gastric.

1:01

Bypass, and their stomach was extremely

1:03

dilated to the level of this extremely

1:05

large gallstone and the excluded loop.

1:08

This is quite dangerous, 'cause

1:09

this is under a lot of pressure.

1:10

Um, the patient can't vomit up any of

1:12

that material because it's in the excluded

1:14

lumen of the stomach after gastric bypass.

1:16

So this is a gallstone, excluding the biliopancreatic

1:19

limb of her gastric bypass.

1:21

Again, birth of a large gallstone.

1:24

You know, this is a surgical emergency.

1:26

There are, of course, a lot of

1:28

other ways things can fistula.

1:29

Once you're talking about fistulas, things

1:31

can fistula left and right, which is amazing.

1:33

Here's a gallbladder, fistulizing to

1:35

the colon causing a colonic obstruction.

1:37

Here's a classic dead white guy name.

1:39

It's Bouveret syndrome for all of you people who took

1:41

French in high school, I did not took Spanish.

1:44

It was easier.

1:45

And this is a gallstone that is

1:47

fistula to the pylorus of the stomach.

1:50

It's a very large gallstone at that and will

1:52

cause gastric outlet syndrome in these patients.

1:55

So, gallstones, gallstones, gallstones.

1:57

We've seen gallstones every way, every how today.

2:00

This is, I believe, the last of

2:02

their appearances in this course.

2:03

And remember that gallstone ileus is yet an

2:06

obstruction and usually needs to be treated surgically.

2:09

If you see pneumobilia, if you see a bunch of stranding

2:12

around the gallbladder and you've lost the stone,

2:14

especially with a stone on a prior, you have to look

2:16

very carefully in the bowel to see if you can find it.

2:19

So gallstone ileus, not exactly common, but if you

2:22

find it, everyone is so happy to make this diagnosis

2:25

because it's something they've read about their

2:27

whole life and it's their opportunity to shine.