Recent gallstone ileus with stone in ileostomy bag

Case contributed by Dr Vikas Shah

Presentation

Abdominal distension and vomiting.

Patient Data

Age: 75 years
Gender: Female
CT

CT abdomen and pelvis from 4 years earlier

There are a number of stones within the gall bladder. A lipid density right renal lesion is an angiomyolipoma. The small and large bowel are in continuity.

In the intervening period, the patient underwent bowel surgery, with formation of a right-sided end ileostomy.

CT

CT abdomen and pelvis of current presentation

Multiple distended loops of small bowel. Radio-opaque oval-shaped lamellated structure within stoma bag. Pneumobilia. Multiple small stones within gall bladder, with an ill-defined interface between the gall bladder and adjacent duodenum. Defunctioned large bowel.

Annotated image

Key images from both studies

The green arrows show the stone within the gall bladder on the earlier CT, which has then migrated into the ileostomy bag on the CT of the acute presentation.

Case Discussion

The cause of the current presentation was considered to be resolving small bowel obstruction secondary to gallstone ileus. The resolution was due to the passage of the gallstone through the small bowel into the ileostomy bag. Unfortunately, by the time I reached the ward to check the stoma bag content, the bag had been emptied by the nursing staff. 

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Case information

rID: 71460
Published: 7th Oct 2019
Last edited: 5th Nov 2019
Inclusion in quiz mode: Included

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