Gallstone ileus

Case contributed by Dr Michael P Hartung

Presentation

Abdominal pain, nausea, vomiting.

Patient Data

Age: 50 years
Gender: Female
CT

Gallbladder contraction, wall thickening, and small amount of intraluminal gas. Thin fluid channel between gallbladder and duodenum consistent with cholecystoduodenal fistula. Gallstone in distal ileum resulting in small bowel obstruction. 

Axial arrow: intraluminal gallstone causing obstruction. 

Coronal arrow: cholecytoduodenal fistula. 

Case Discussion

Gallstone ileus occurs when a gallstone erodes through the gallbladder into the duodenum, resulting in small bowel obstruction. It is more common in elderly women. It results in Rigler triad i.e. pneumobilia, small bowel obstruction, and ectopic gallstone. The gallstone can be difficult to see and often blends in with the bowel contents. Therefore, close examination of the gallbladder is required in every distal SBO case. Don't be fooled if you are incorrectly given the history of cholecystectomy! The channel between the gallbladder and small bowel is called a cholecystenteric fistula. 

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Case information

rID: 59025
Published: 17th Mar 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included
Institution: Ascension Healthcare

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