Presentation
Intermittent symptoms of nausea, vomiting, and abdominal distension.
Patient Data
CT scan demonstrates the Rigler triad
- small bowel obstruction
- gas in biliary tree
- large ectopic gallstone
Other findings include collapsed gallbladder and gas in the gallbladder. Oral contrast is also seen in the gallbladder.
The gallstone can be seen in this intraoperative picture. The distended afferent bowel loop proximal to the obstruction is noted.
Case Discussion
Gallstone ileus is a rare cause of bowel obstruction. Having a systemic approach and clinical suspicion is important in diagnosis. Gallstone ileus is more common in women since gallstones are more common in women. The stone fistulizes into the duodenum and the site of obstruction is often at the terminal ileum since it is the narrowest portion of the small bowel.
Plain radiography would show a small bowel obstruction and sometimes gas in biliary tree and gallbladder. If radiopaque, the stone may be seen as well. The same findings are present on CT, but the ectopic gallstone is easier to see.