INTESTINAL OBSTRUCTION RESULTING FROM BILIARY CALCULI (GALLSTONE ILEUS)

THE COMMONEST entry of biliary calculi into the intestinal tract is by way of a cholecystoenteric fistula. However, a choledochoenteric fistula and, when the stones are small enough, the ampulla of Vater also serve as pathways.¹Fistulization between the biliary and intestinal tracts occurs as a complication of either cholecystitis caused by a calculus²or a perforating gastric or duodenal ulcer which penetrates the gall-bladder wall.³The present series deals with seven instances of the former condition, which occurred in six patients at the Harbor General Hospital. With the establishment of the fistulous tract, any stones trapped within a distended inflamed gall bladder find their escape into the intestinal tract and thus relieve the acute obstructive cholecystitis.⁴If, as usually happens, the calculi are of a small diameter, as compared with the intraluminal diameter of the narrowest portion of the intestinal tract, the stone will pass out through the