Gallstone ileus

Case contributed by Dr Ammar Haouimi

Presentation

Bilious vomiting with a distended abdomen. Past history of recurrent right upper abdominal pain.

Patient Data

Age: 70 years
Gender: Male
CT

A large fistulous track is seen between the gallbladder and duodenal lumen with gas within gallbladder as well as intra / extrahepatic biliary ducts (pneumobilia). The gallbladder itself shows thickened wall indicating chronic inflammatory changes.

 A large gallstone (5 cm) impacted within the distal jejunum with distended proximal jejunal loops and collapsed ileal loops as well as the terminal ileum and colon.

Hemangioma of the liver (segment I). Small solid nodule of the left adrenal gland (incidentaloma). A lipoma of the right gluteus medius muscle is noted.

Case Discussion

Gallstone ileus is considered as a rare complication of chronic cholecystitis with cholecystodudoenal fistula and passage of gallstones into the GIT lumen, causing a mechanical small bowel obstruction.

This case shows the classical Rigler triad: 

  • ectopic gallstone
  • bowel obstruction
  • pneumobilia

Additional contributors: A. Ramdani M.D, Z.E Boudiaf M.D, F. Bouamra M.D.

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Case information

rID: 62229
Published: 7th Aug 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Aurès Medical Imaging Center - Batna Algeria

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