Gallstone ileus

Case contributed by Jernej Lučev

Presentation

3 weeks history of right upper quadrant abdominal pain, nausea, vomiting and diarrhea.

Patient Data

Age: 65 years
Gender: Male
ct

The study shows gallbladder wall thickening with a cholecystoduodenal fistula, small bowel dilatation, and a gallstone at the transition point. Slight dilatation of the central intrahepatic biliary radicles is noted as well. The findings are compatible with gallstone ileus.

Case Discussion

Gallstones can lead to recurrent cholecystitis. Due to the anatomical proximity of the gallbladder and small bowel, the recurrent inflammation can lead to the formation of fistula. The gallstone then passes through the fistula into the intestine where it leads to obstruction. The most common site of obstruction is the terminal ileum, but the obstruction can occur anywhere along the intestine.

The classical radiological finding in gallstone ileus is the Rigler triad consisting of pneumobilia, small bowel obstruction and ectopic gallstone, two of which are present in our case.

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