Abdominal plain film - supine position
Abdominal imaging
Case TypeClinical Cases
AuthorsA. Papaevangelou, A. Manataki, E. Kailidou, A. Douridas, V.Katsiva
Patient80 years, female
The plain abdominal radiogragh showed a few dilated small bowel loops and a 4cm rim-calcified opacity in the iliac fossa. The ultrasound scan demonstrated a contracted, stone-filled gallbladder.
CT examination of the upper abdomen showed a contracted gallbladder (with a gallstone in it), which couldn't be distinguished from the duodenum. A small amount of free perihepatic fluid was present. CT examination of the lower abdomen showed a dilated loop within a calcified opacity in contact with the anterior abdominal wall. The distal loops of the ileum were collapsed and a small amount of ascites was found between the mesenteric folds.
She had a short segment enteretomy.
Acute cholecystitis, followed by pericholecystic inflammation can cause adherence of the biliary and enteric systems. Pressure by the gallstone against the biliary wall can eventually cause cholecystoduodenal fistula. The mortality of gallstone ileus is high (15-20%), because of late diagnosis and surgical treatment and also because of the severe health problems that the elderly patients may have.
Usually, gallstones greater than 2.5cm in diameter increase the incidence of impaction and obstruction. The most common site for stone impaction is the ileum, because it is notably the narrowest point in the small or large bowel. [1]
In this case, the features that confirmed our suspicion of gallstone ileus were: the abnormalities of the gallbladder fossa, the free perihepatic fluid, the small bowel obstruction with transition point, and the calcified intraluminal lesion, even in the absence of pneumobilia, i.e.gas within the bile ducts. [2]
In the case of gallstone ileus, CT was the only imaging procedure that was able to give valuable information and provides a definite pre-operative diagnosis.
URL: | https://eurorad.org/case/1467 |
DOI: | 10.1594/EURORAD/CASE.1467 |
ISSN: | 1563-4086 |