Presentation
Abdominal pain, vomiting and absolute constipation.
Patient Data
CT scanogram showing distended small bowel loops and pneumobilia.
Non visualized gallbladder with gas densities at gallbladder fossa and proximal biliary tree.
A large dense ectopic gall stone is seen at the right iliac fossa within the distal ileum measuring 3.2 x 2.3 cm in diameters with proximal 8 cm ileal segment mural enhancement seen.
Subsequent dilatation of the proximal small bowel with multiple air fluid levels seen.
The liver is mildly enlarged showing homogeneous low CT texture denoting fatty infiltration. No focal lesions or contour irregularities. Normal appearance of the spleen, pancreas, kidneys (apart from left cortical renal cyst) aorta, I.V.C and both adrenal glands.
No pelvic or abdominal lymph node enlargement seen. No ascites.
Sliding esophageal hiatal hernia is noted. Small right inguinal omentum containing hernia.
Case Discussion
The triad of pneumobilia, small bowel obstruction and right iliac fossa gallstone are diagnostic of gallstone ileus (Rigler triad).
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