Gallstone ileus

Case contributed by Dr Rish Ratnalingam

Presentation

Abdominal pain and vomiting.

Patient Data

Age: 85 years
Gender: Male
X-ray

There are dilated gas-filled loops of small bowel seen throughout the upper abdomen. Within the right lower abdomen, projected over the right iliac crest, is a well-demarcated calcified opacity.

CT

Small bowel loops are dilated and fluid filled with a transition point in the right lower abdomen. There is a high-density intraluminal object at the transition point within the distal ileum. The terminal ileum and large bowel are collapsed.

There are small flecks of gas within the biliary tree. The gallbladder is collapsed with evidence of luminal gas. There is a fistulous communication between the gallbladder and the duodenum (cholecystoduodenal fistula).

Small collection seen adjacent to the gallbladder.

Case Discussion

Imaging features are consistent with mechanical small bowel obstruction secondary to migrated gall stone through cholecystoduodenal fistula (gallstone ileus).

Findings confirmed surgically. Patient underwent successful laparoscopy and disimpaction of calculus into large bowel.

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Case information

rID: 66721
Published: 7th Mar 2019
Last edited: 18th Apr 2019
Inclusion in quiz mode: Included
Institution: The Mid Yorkshire Hospitals

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