CT
Axial C+ portal venous phase
Coronal C+ portal venous phase
The presence of a small bowel obstruction, pneumobilia and a gallstone in the lower abdomen are the three classic findings in gallstone ileus. What is this constellation of findings known as?
Rigler's triad.
Explain how gallstone ileus occurs.
Repeated bouts of cholecystitis result in adhesion of the gallbladder to the small bowel (usually duodenum) with eventual fistula formation and passage of gallstones into the lumen of the bowel. Small stones presumably pass without incidence, however large cholesterol stones can become impacted typically at the ileocecal valve.
A 3 cm calcified gallstone is seen at the point of transition between dilated fluid filled proximal small bowel, and collapsed distal small bowel.
Gas is confirmed to be present at the liver hilum, confined to the biliary tree.