Gallstone ileus

Case contributed by Dr Jeremy Jones ◉

Diagnosis certain

Presentation

Vomiting and abdominal distension. Clinical small bowel obstruction.

Patient Data

Age: 80 years

Gender: Female

From the case: Gallstone ileus

X-ray

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Frontal

Distended loops of gas-filled small bowel. Features consistent with small bowel obstruction. No evidence of perforation.

From the case: Gallstone ileus

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Scout

Features of small bowel obstruction with gas- and fluid-filled loops of bowel. Transition point in the midline of the pelvis with a large calcfified gallstone.

Biliary gas with gas in the gallbladder and a visible fistula between the gallbladder and duodenum.

Case Discussion

Large gallstones cause gallbladder distension with opposition of the gallbladder and duodenal walls. When there is a long-standing irritation between the two, fistula can form. Once a small fistula forms, constant irritation from the gallstone causes its enlargement until the gallstone can escape.

Once the fistula has formed, gas can be demonstrated in the biliary tree and gallbladder.