Summary: An 86-year-old man was brought to the emergency department with
progressive abdominal pain. Clinically, small bowel obstruction was
suspected. Computed tomography (CT) examination was fol-lowed by
Two unenhanced abdominal CT images in this patient with
progressive abdominal pain show dilated small bowel proximal to a
laminated gallstone with transition to normal caliber distal small
bowel and colon, compatible with small bowel obstruction (figure
1). Figure 2 shows pneumobilia from a cholecystoenteric fistula.
The presence of bowel obstruction, air in the biliary tree, and a
radio-opaque gallstone within the gastrointestinal tract is the
classic radiographic triad described with gallstone
Gallstone ileus, a rare and potentially serious complication of
cholelithiasis, occurs when a gallstone erodes through the wall of
the gallbladder into the gastrointestinal tract. Bowel obstruction
may occur when larger stones (usually >2 cm) become lodged at
narrow portions of the gastrointestinal tract, such as the
duodenum, ligament of Treitz, ileocecal valve, and sigmoid
colon.1,2 Clinical diagnosis is difficult2-4
and radiographic examinations are frequently
inconclusive.3-5 Computed tomography (CT) may result in
more rapid and specific diagnosis.4,6,7
- Zeman RK:Cholelithiasis and cholecystitis. In:
Gore RM, Levine MS, Laufer I (eds): Textbook of Gastrointestinal
Radiology, pp 1651-1652. W.B. Saunders Co, 1994.
- Day EA, Marks C:Gallstone ileus. Review of the
literature and presentation of thirty-four new cases. Am J Surg
- Reisner RM, Cohen JR:Gallstone Ileus: A review
of 1001 reported cases. Am Surg 60:441-446, 1994.
- Seal EC, Creagh MF, Finch PJ: Gallstone ileus:
A new role for computed tomography. Postgrad Med J 71:313-315,
- Balthazar EJ, Schechter LS:Gallstone ileus.
The importance of contrast examinations in the roentgenographic
diagnosis. Am J Roentgenol Radium Ther Nucl Med 125:374-379,
- Loren I, Lasson A, Nilsson A, et al: Gallstone
ileus demonstrated by CT. J Comput Assist Tomogr 18:262-265,
- Oikarinen H, Paivansalo M, Tikkakoski T, Saarela
A: Radiological findings in biliary fistula and gallstone
ileus. Acta Radiol 37:917-922, 1996.
- Rigler LG, Borman CN, Noble JF:Gallstone
obstruction: Pathogenesis and roentgen manifestations. JAMA