Which of the following is the most common site of intestinal obstruction in a case of gallstone ileus?
## **Core Concept**
Gallstone ileus is a rare but important cause of intestinal obstruction, occurring when a gallstone enters the bowel through a fistula between the gallbladder and the intestine, most commonly the duodenum. The obstruction typically happens at a narrow part of the intestine.
## **Why the Correct Answer is Right**
The terminal ileum is the most common site for gallstone ileus to cause intestinal obstruction. This is because the terminal ileum is a relatively narrow part of the intestine, making it more susceptible to obstruction by a large gallstone. The terminal ileum's smaller diameter compared to other parts of the intestine increases the likelihood that a stone will get stuck here.
## **Why Each Wrong Option is Incorrect**
* **Option A:** The duodenum is the common site for fistula formation between the gallbladder and intestine but is less commonly the site of obstruction due to its larger diameter compared to the terminal ileum.
* **Option B:** The jejunum, being part of the small intestine with a larger diameter than the terminal ileum, is less likely to be obstructed by a gallstone.
* **Option C:** The large intestine (colon) can be obstructed by a gallstone, but this is less common compared to the terminal ileum due to its larger diameter.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that gallstone ileus typically presents in elderly patients with a history of gallstones and often with signs of intestinal obstruction. The diagnosis can be made with abdominal X-rays showing signs of obstruction and sometimes the stone itself.
## **Correct Answer:** . Terminal Ileum