Gallstone obstruction of the small intestine]

Six cases of gallstone obstruction of the small intestine are discussed. They were of interest because the operations were carried out by the same team of surgeons which made it possible to perfect the operative techniques. After intubation of the small intestine and aspiration of its contents, the stone was moved proximally for a distance of 40-50 cm. Enterotomy was conducted above the concrement. The intestine was cut for no more than 2 cm. The concrement was removed by exerting pressure on its lower pole. Although the size of the stone doubled versus the intestinal incision, the latter did not rupture in any of the cases and acquired the initial size. As a result, the intestinal suture was small, accurate, and did not distort the intestinal lumen. The nasointestinal catheter for postoperative decompression of the intestine was advanced to the ileocecal angle. Gallstone intestinal obstruction is characterized by an atypical (obscure) clinical picture which causes diagnostic difficulties and leads to delayed operative treatment. The obstruction is partial, the concrement moves continuously along the intestine, and the level of the obstruction is determined by the duration of the disease.