Suspected bowel obstruction needs urgent care
Abdominal pain with repeated vomiting, significant swelling or an inability to pass wind and stools needs immediate hospital assessment. Call emergency services if pain is severe or constant, or the person faints, becomes confused or rapidly weakens. Do not wait for a routine gallbladder appointment.
Do not try to resolve this combination with laxatives, enemas, gallbladder flushes or a large meal. These measures can delay necessary treatment. Follow the emergency team’s instructions about eating, drinking and usual medicines. Passing a stool early in the illness does not guarantee that there is no obstruction.
What gallstone ileus means
Gallstone ileus is a rare condition in which a gallstone blocks the bowel. Despite the name, it is a mechanical obstruction, not simply the temporary slowing of bowel movement that can occur after an operation. It is also different from a stone blocking the common bile duct. The site of the blockage, and therefore the treatment, is different.
The stone usually enters the bowel through a fistula: an abnormal connection between the gallbladder and a neighbouring part of the digestive tract. Prolonged inflammation and pressure from a stone can contribute to this connection. A stone then travels along the bowel until it becomes stuck. Not every fistula causes obstruction, and not every stone entering the bowel becomes lodged.
NHS Inform describes this as a rare but serious complication. A stone measurement on an old ultrasound cannot predict an individual outcome by itself. Where the stone enters, bowel width and other anatomical changes also matter.
How it may present
Pain may come in waves and later become continuous. Nausea, vomiting, abdominal swelling and difficulty eating or drinking can develop. With a more complete blockage, wind and stools may stop passing. Symptoms can initially ease and return, so a brief improvement does not establish that the problem has resolved.
The person may never have been diagnosed with gallstones or experienced typical gallbladder attacks. Jaundice is not required because the obstruction is in the bowel. At home, this cannot be distinguished reliably from other causes of bowel obstruction, such as adhesions or a hernia. Recognising a dangerous symptom combination matters more than identifying its precise cause yourself.
Why hospital treatment matters
Vomiting and fluid accumulating within the bowel can cause dehydration and disturbances in blood salts. A persistent blockage can damage the bowel, including its blood supply, and may lead to perforation or infection. The NHS bowel obstruction leaflet explains why these symptoms should not be treated as routine constipation.
Hospital care includes assessing the person’s condition, taking blood tests and correcting fluid and electrolyte losses. A tube through the nose into the stomach may be needed to remove accumulated contents and reduce vomiting. These measures support the patient but do not establish that the lodged stone has been removed.
Finding the cause
An abdominal CT scan often helps identify the obstruction site, a stone outside the gallbladder and changes in surrounding tissue. It may also show air in the bile ducts or the fistula itself. Not every feature is visible on every scan, so the diagnosis rests on the overall findings.
Ultrasound, X-rays or other tests may add information. Normal bilirubin or an older reassuring ultrasound cannot exclude a new bowel emergency. Tell the team about previous operations, hernias and medicines as well as any gallstone history.
Which operation may be needed?
Treatment usually requires removal of the mechanical obstruction. A surgeon may open the bowel to extract the stone. If part of the bowel is badly damaged, removing that segment may be necessary. The extent of treatment depends on the tissue and the patient’s condition, not just the name of the diagnosis.
Gallbladder removal and fistula closure are not always performed at the same operation because they can add complexity and operating time. Sometimes relieving the obstruction is the immediate priority, with decisions about the gallbladder and fistula reviewed after recovery. A combined procedure may be appropriate in other circumstances. Research comparing surgical approaches does not establish one universally best operation for every patient.
After treatment
Before discharge, ask whether stones remain, what is known about the fistula and whether further investigation or surgery is planned. Restarting food depends on bowel recovery and the operation performed. Instructions for an uncomplicated gallbladder removal should not automatically be applied to surgery for bowel obstruction.
New pain, swelling, repeated vomiting or inability to pass wind needs prompt reassessment. Keep the discharge summary describing the exact procedure and the treating team’s contact details. For broader background, read about gallbladder stones.
Frequently asked questions
Can I just wait for the stone to pass?
Waiting at home with obstruction symptoms is unsafe. The hospital team decides treatment after assessing the bowel and the patient’s condition.
Would a standard ERCP remove it?
ERCP treats the bile ducts. It is not the standard method for removing a stone lodged farther along the bowel.
Does gallstone ileus always cause jaundice?
No. Lack of jaundice does not exclude bowel obstruction caused by a gallstone.
Is the fistula always closed during the first operation?
No. That is a separate decision based on risks, anatomy, remaining stones and the course of recovery.
This article provides general information and does not replace assessment and individual advice from a clinician.