Gallstone ileus and complete situs inversus

Case contributed by Dr Chris O'Donnell

Presentation

Abdominal pain and vomitting. Gas in biliary tree on plain abdominal x-ray. Known situs inversus.

Patient Data

Age: 90
Gender: Female
Modality: CT

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).

Case Discussion

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.

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Case Information

rID: 34548
Case created: 25th Feb 2015
Last edited: 27th Sep 2016
Inclusion in quiz mode: Included

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