Presentation
Abdominal pain and vomiting. Dementia.
Patient Data
Pneumobilia.
Round calcific density in the pelvis just right of the midline.
Prominent loop of small bowel in the upper abdomen.
The small bowel is fluid filled and dilated.
Two intraluminal gallstones in the distal small bowel measuring approximately 3.5 and 2 cm.
The distal small and large bowel are normal in caliber.
Small amount of free fluid in the pelvis. No free gas.
The gallbladder is collapsed and contains small gas locules with a fistula between the gallbladder and the second part of the duodenum.
Pneumobilia. Small D2 diverticulum.
The liver parenchyma, spleen, adrenals and urinary bladder are unremarkable.
Both kidneys have a multi-cystic appearance.
Bilateral basal atelectasis and consolidation.
Case Discussion
A full house of CT features of gallstone ileus. Rigler triad is illustrated.
In this case, it is a 'double stone' gallstone ileus.
The clinical background was also classical with an elderly dementia patient with a long history of documented gallstones.
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