CASE 1467 Published on 24.04.2002

Gallstone ileus

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

A. Papaevangelou, A. Manataki, E. Kailidou, A. Douridas, V.Katsiva

Patient

80 years, female

Categories
No Area of Interest ; Imaging Technique CT
Clinical History
The patient was admitted to hospital complaining of severe abdominal pain of several days' duration, nausea, vomiting and obstipation. Physical findings revealed abdominal distension and routine biochemical and haematological tests were within normal limits.
Imaging Findings
The patient was admitted to hospital complaining of severe abdominal pain of several days' duration, nausea, vomiting and obstipation. Physical findings revealed abdominal distension and routine biochemical and haematological tests were within normal limits. She typically disclosed leukocytosis, elevated BUN and electrolyte imbalance.

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.

Discussion
Gallstone ileus is a mechanical small bowel obstruction caused by the impaction of a gallstone within the lumen of the intestine. It is primarily found in elderly females.

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.

Differential Diagnosis List
Gallstone Ileus
Final Diagnosis
Gallstone Ileus
Case information
URL: https://eurorad.org/case/1467
DOI: 10.1594/EURORAD/CASE.1467
ISSN: 1563-4086