Gallstone ileus

Bradley S. Gluck, MD; William R. Brancaccio, MD; David Kirshy, MD

View content online at: http://www.appliedradiology.com/Issues/2000/12/Cases/Gallstone-ileus.aspx

Abstract:  n 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 laparotomy.

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Diagnosis

Gallstone ileus

Findings

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 ileus.8

Discussion

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

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  3. Reisner RM, Cohen JR:Gallstone Ileus: A review of 1001 reported cases. Am Surg 60:441-446, 1994.
  4. Seal EC, Creagh MF, Finch PJ: Gallstone ileus: A new role for computed tomography. Postgrad Med J 71:313-315, 1995.
  5. 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, 1975.
  6. Loren I, Lasson A, Nilsson A, et al: Gallstone ileus demonstrated by CT. J Comput Assist Tomogr 18:262-265, 1994.
  7. Oikarinen H, Paivansalo M, Tikkakoski T, Saarela A: Radiological findings in biliary fistula and gallstone ileus. Acta Radiol 37:917-922, 1996.
  8. Rigler LG, Borman CN, Noble JF:Gallstone obstruction: Pathogenesis and roentgen manifestations. JAMA 117:1753-1759, 1941.