Biliary System
Last updated (28 October 2003)
Good Stuff
Spot Diagnosis
Biliary System
Padding space Perforated Gallbladder
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Perforated Gallbladder Click on the image to download a larger version
Which of the following statements regarding the size of gallstones and the problems they cause are true?
Small gallstones are more likely to cause bilio-enteric fistulae
Large gallstones are more likely to cause instestinal obstruction
Pancreatitis is mainly associated with large gallstones
Gallstone associated obstructive jaundine usually indicates small stones
Large gallstones outside the bile duct may cause obstructive jaundice

The answer

Small gallstones are more likely to escape through the cystic duct into the bile duct and cause jaundice and pancreatitis. Large gallstones may escape via fistualisation into the duodenum to cause gallstone ileus. Alternatively a stone impacted in Hartman's pouch that is too large to escape down the cystic duct may attempt to fistulate into the common bile duct. Swelling around the stone impacted in Hartman's pouch may cause a narrowing of the common bile duct and thus obstructive jaundice. This is called the Mirizzi syndrome.

Small Print

Larger gall stones are more likely to be associated with bilio-enteric fistulae and intestinal obstruction.

Pancreatitis and obstructive jaundice due to gallstones are in the main associated with small gallstones that can escape into the bile duct via the cystic duct.

Larger gallstones stuck in Hartman's pouch can be associated with oedema and swelling that obstructs the adjacent bile duct, this is termed Mirizzi syndrome.

Adrian P. Ireland