Presentation
Vomiting and abdominal pain. Chronic cholecystitis.
Patient Data
A biliary calculus measuring 2.8×3.3×4.2 cm is seen in the jejunum with distention of the stomach and bowel proximal to it.
The gallbladder wall is thickened with multiple small gallstones within.
The patient was given oral contrast during the exam (noted in the second T1WI) where the stomach and proximal bowel appeared distended with high T1 signal fluid; this high T1 signal fluid was also observed in the gallbladder which indicated a bilioduodenal fistula.
Previous CT showed the gallstone in the distal part of the duodenum. Since only the minority of gallstones are calcified (12.5%), and their density is similar to regular bowel content, the gallstone was overlooked.
NG tube in the stomach.
Postoperative image showing the obstructing gallstone.
Case Discussion
Gallstone ileus is a rare complication of recurrent chronic cholecystitis and an uncommon cause of mechanical small bowel obstruction, mainly affecting the elderly. It occurs when a gallstone passes through a fistula between the gallbladder and small bowel and gets impacted in the gastrointestinal tract.
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