Gallstone ileus and complete situs inversus
Abdominal pain and vomitting. Gas in biliary tree on plain abdominal x-ray. Known situs inversus.
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Note both heart and abdominal contents are inverted. Small contracted gall bladder (arrow) containing gas with a fistula to the duodenal cap (arrow) and gas in the biliary tree (arrow). Large poorly calcified mass (stone) in the distal small bowel (left iliac fossa) with abrupt transition to collapsed ileum (arrow).
This case has all the features of gallstone ileus but is difficult to interpret due to the complete situs inversus. In fact I horizontally flipped the images on the workstation whilst reporting (as it was doing my head in the other way) and substituted right for left in the dictation. It worked a treat! I have flipped images back the correct way for Radiopaedia.