Gallstone ileus

Case contributed by Dr Vikas Shah

Presentation

2 days of abdominal pain, distension and vomiting.

Patient Data

Age: 55 years
Gender: Male
CT

Scout image from CT

Branching gas seen in the right upper quadrant. Gas filled and dilated small bowel loops.

CT

CT abdomen and pelvis

There is gas within the intra- and extra-hepatic biliary tree. The gall bladder and adjacent duodenum are thick walled and inflamed with a fistula between the two structures. The small bowel is distended and there is a 5 cm stone in the lumen at the transition point. No other similar intraluminal filling defects are noted.

Incidental findings include an area of rounded atelectasis in the left lower lobe, cardiomegaly, bilateral inguinal hernia and an enlarged prostate.

Case Discussion

The scout film from the CT shows 2 of the 3 components of the Rigler triad: pneumobilia and small bowel obstruction. The CT shows the third component: a gallstone at the site of obstruction. Chronic cholecystitis leads to a cholecysto-duodenal fistula and migration of gallstone(s) into the small bowel where they may cause obstruction if large enough. It is important to avoid satisfaction of search and thoroughly examine the small bowel for any additional stones such that they can all be retrieved during surgery. A single stone was successfully retrieved in this case with an uneventful recovery.

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Case information

rID: 55028
Case created: 15th Aug 2017
Last edited: 20th Nov 2017
Inclusion in quiz mode: Included

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