Presentation
Vomiting. Admitted for follow-up.
Patient Data
Supine and cross-table AP films showed dilated small bowel loops in a stepladder configuration, measuring up to 5 cm in diameter and containing air-fluid levels. Small bowel loops are more dilated compared with radiographs from the previous day (not shown), which were suspicious for partial small bowel obstruction.
Intravenous contrast material not administered due to chronic renal failure.
Nasogastric tube in the stomach.
Right basal pulmonary consolidation with air bronchogram. Moderate right-sided pleural effusion.
Cholecystoduodenal fistula evident with an air-contrast material level in the gallbladder and pneumobilia in the left biliary tree and common bile duct.
Case Discussion
This case nicely demonstrates gallstone ileus with partial small bowel obstruction.
Incidentally, the patient had quite a few diverticula: duodenal, sigmoid, and urocystic.
An important lesson to be learned from this case is to remove all removable metal objects from the patient prior to scanning, lest they cause harsh artifacts.