Presentation
Abdominal pain and vomiting for several days.
Patient Data
Several loops of small bowel dilated up to 5 cm of in left abdomen, cause unapparent. Paucity of bowel gas elsewhere. Gas-fluid levels seen in small bowel loops in left abdomen on lateral decubitus film.
Fistula between the gallbladder and duodenal bulb, with a gas-contrast level in both (same level). Thickened gallbladder wall. Intra and extrahepatic bile ducts not dilated.
Small bowel loops dilated up to 4.0 cm, several in the left abdomen with a string of pearls sign and gradual dilution of contrast material. Large stone with laminar calcification in the distal ileum. The terminal ileum and colon are collapsed.
Minute amount of free perihepatic fluid.
Atrophic kidneys. Right kidney has a small peripelvic cyst in the upper pole calyx. Left kidney: tiny calcific focus in lower calyx - arterial calcification? renal calculus?
Beam hardening artifact from undiluted contrast material in the stomach.
Case Discussion
A clear case of gallstone ileus.
The patient went on to have an enterotomy whereby the gallstone was removed from the terminal ileum.
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