Presentation
Abdominal pain and distension. ? Bowel obstruction.
Patient Data
Age: 75 year old
Gender: Male
From the case:
Gallstone ileus within a hernia sac
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- Multiple dilated loops of small bowel
- Large right paramidline hernia sac
- Ill-defined opacity demonstrated within the hernia sac projected just inferior to the right lesser trochanter
- Left total hip arthroplasty
From the case:
Gallstone ileus within a hernia sac
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- Large partially calcified ovoid calculus within a loop of small bowel, which is within a small-bowel containing low anterior abdominal wall hernia
- Focal transition point at the calculus
- The gallbladder is collapsed with the appearance of a fistulous tract extending from the gallbladder to the duodenum
Case Discussion
This case illustrates a gallstone ileus causing a mechanical small bowel obstruction with the transition point coincidently located within an anterior abdominal wall hernia.
Interestingly, the culprit gallstone was seen within the gallbladder lumen on a prior CT from a few years prior when the patient actually presented with a mechanical small bowel obstruction associated with the same lower abdominal wall hernia.
With thanks to Dr. Jacob Gipson for case.