Gallstone ileus

Case contributed by Dr Ahmed Samir

Presentation

Abdominal pain, distension and repeated vomiting.

Patient Data

Age: 70 years
Gender: Female
CT

Dilated fluid-filled stomach, duodenum and jejunal loops (maximum diameter about 4 cm) until the mid jejunum where a dense laminated structure measuring approximately 2.5 cm is seen, the distal bowel loops are collapsed.

Pneumobilia in the intra and extrahepatic bile ducts.

Collapsed gall bladder with thickened edematous wall and few tiny air foci noted inside.

Multiple colonic diverticula are noted with no significant inflammatory changes.

Photo

Intraoperative photo of the large migrated gallstone extracted from the small bowel.

Case Discussion

The patient went for surgery and a large stone was extracted from the dilated obstructed jejunum, the bowel was viable.

The case shows the classical findings of Rigler's triad.

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