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Gallstone ileus

Case contributed by Dr Matthew Lukies

Presentation

2 week history of vomitting. Query bowel obstruction.

Patient Data

Age: 85 years
Gender: Male
CT

CT findings include:

  • pneumobilia with gas shown in the gallbladder
  • tract of inflammation and fistula between the anterior gallbladder wall and duodenum
  • dilated small bowel loops measuring up to 4 cm in diameter
  • gallstone within the jejunal lumen
  • right inguinal hernia containing small bowel, but not causing obstruction
  • small volume of free pelvic fluid

Case Discussion

CT findings are consistent with gallstone ileus. The patient in this case proceeded to laparotomy where the diagnosis of gallstone ileus was confirmed and the gallstone removed by jejunostomy.

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