Gallstone ileus

Case contributed by Dr Ian Bickle

Presentation

Brown stained vomitus, palpable small bowel loops. Bowel obstruction?

Patient Data

Age: 85 years
Gender: Female
X-ray

Prominent small bowel loops centrally in the pelvis.

Air in the CBD.

Calcified density in the midline of the pelvis.

CT

Pneumobilia in the left hepatic lobe. Cholecystoduodenal fistula.

1.5 cm calculus in the terminal ileum approximately 5-10 cm from the ileocecal valve. The small bowel loops proximal to this are distended with fluid.

Kidneys, adrenals, spleen and pancreas appear normal.

Case Discussion

The plain radiograph demonstrates the Rigler triad of:

CT confirmed the plain radiograph suspicion of gallstone ileus.

The plain radiograph is a classic fellowship viva case.

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