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