Gallstone Ileus

Case contributed by Joshua Freeman
Diagnosis certain


Presented with postprandial epigastric/right upper quadrant abdominal pain for two days with bilious vomiting and constipation.

Patient Data

Age: 60 years
Gender: Female

Calcified gallstone can be seen in the ileum with dilation of proximal small bowel loops.

Pneumobilia is present surrounding the gallbladder and bile hepatic duct, suggestive of a cholecystoduodenal fistula.

Additionally, there is a small radiopaque density outside the gallbladder lumen, likely from gallbladder rupture/fistula likely a gallstone.

Widespread diverticular disease of the colon can be seen with several calcified diverticula.

Case Discussion

Patient presented with postprandial right upper quadrant abdominal pain, bilious vomiting and constipation, concerning for small bowel obstruction. CT demonstrated pneumobilia, concerning for fistula between the gallbladder and duodenum. Also seen on CT was a calcified mass in the ileum with upstream dilation of proximal small bowel. This patient's presentation was consistent with the Rigler Triad and she was taken to surgery and they retrieved a 5 cm stone.


Acknowledgements: Case reviewed by and written in conjunction with radiology resident, Haziq Zahir, D.O.

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