Imaging of Gallstone Ileus

Abstract

Gallstone ileus is a rare complication of chronic cholecystitis with gallstone associated with high mortality rate (about 8-30%). It occurs when a stone passes into the small bowel and characterized by partial or complete small bowel obstruction. Gallstone ileus usually occurs in the elderly patient with a female predominance. The imaging diagnosis can be confirmed by plain abdominal radiography, ultrasound and CT scan which demonstrate Rigler’s triad: intestinal obstruction, pneumobilia and ectopic gallstone. We report imaging findings of a case of gall stone ^ileus. A 77 years old man presented with right lower quadrant pain and fever for 2 days. Physical examination showed fever (temperature 38.5° C), mark tender at right lower abdomen with voluntary guarding. Plain abdomen radiograph showed partial small bowel obstruction. The initial diagnosis was acute appendicitis. Ultrasound findings were generalized bowel dilatation and well-defined laminated hyperechoic lesion size about 2.4x2.9 cm. in distal small bowel which suspect stone. CT scan was performed which demonstrate generalized small bowel dilatation and visible large laminated calcific lesion at terminal ileum. Operative findings were shown gallstone size about 2x 2 cm. at terminal ileum, small pore at duodenum and gallbladder , adhesion at 1^st part of duodenum. Surgical treatment was explored with enterotomy, cholecystectomy, repaired duodenum with omental patch, hepatoduocojejunostomy and jejunojejunostomy with bowel loop