What is the recommended management of small bowel obstruction due to gallstone ileus?

The recommended management for small bowel obstruction due to gallstone ileus involves performing a terminal ileal enterotomy to remove the obstructing gallstone, along with decompression of the small bowel. This approach directly addresses the cause of the obstruction, which is critical in preventing complications that can arise from prolonged bowel obstruction, such as bowel ischemia and perforation.

In gallstone ileus, a gallstone can get lodged in the intestinal lumen, typically following a fistula between the gallbladder and the bowel, leading to a mechanical obstruction. The important therapeutic goal is to relieve the obstruction while also addressing the source of the problem by removing the gallstone. The terminal ileal enterotomy allows for direct access to the impacted gallstone, which can be retrieved without needing extensive resection of the bowel. Following stone removal, the small bowel can be decompressed, which helps restore normal bowel function and alleviates the symptoms of obstruction.

Other management strategies, such as observation for spontaneous resolution, may not be appropriate in this context because the obstruction is caused by a definitive mechanical blockage rather than a transient problem that might resolve on its own. Similarly, resection of the obstructed bowel segment is not the preferred first-line approach unless there is significant bowel nec