Gallstone ileus

Case contributed by Michael P Hartung
Diagnosis certain


Abdominal pain, nausea, vomiting.

Patient Data

Age: 60 years
Gender: Female



The gallbladder is collapsed, wall thickened, enhancing, containing a small amount of air. Cholecystoduodenal fistula to the 2nd portion of the duodenum (very clear on coronal images). 

Diffuse dilation of fluid-filled loops of small bowel. Transition point at intraluminal gallstone in mid-ileum. 

1 month previously


The same gallstone which caused the obstruction at presentation is in the gallbladder. Mild gallbladder wall thickening and inflammation are present. Hazy inflammation between the gallbladder wall and 2nd portion of the duodenum, paving the way for the formation of the cholecystoduodenal fistula. 

Case Discussion

Gallstone ileus with typical findings of cholecystoduodenal fistula and small bowel obstruction due to a large, oval intraluminal gallstone. 

The CT performed 1 month before presentation has subtle findings of inflammation between the gallbladder and second portion of the duodenum, showing the precursor to fistula formation. 

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