Case of the Week: Gallstone Ileus (X-ray & CT)

In this radiology lecture, we discuss the appearance of gallstone ileus on x-ray and CT.
Key points include:
1) Gallstone ileus is a rare complication of chronic cholecystitis.
2) Actually not an ileus, but a small bowel obstruction.
3) Gallstone migrates through a fistula between gallbladder and small bowel (usually duodenum) and becomes impacted in the terminal ileum.
4) Stone can also impact in the proximal ileum, jejunum, even in the duodenum/distal stomach causing gastric outlet obstruction (Bouveret syndrome).
5) Rigler triad on abdominal x-ray: Small bowel obstruction, pneumobilia and gallstone in the right iliac fossa.
6) Usually affects the elderly and treated surgically.
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[@Dr_amoljadhav2607]

Thank u soo much

[@Radquarters]

Most welcome 😊

[@ivanmamontov1715]

Great case ! Thank you !

[@Radquarters]

You are welcome Ivan, and thanks for watching!

[@abukeabdela4928]

Loved it

[@Radquarters]

Great to hear!

[@salmanausheenmuzaffar3364]

Excellent

[@Radquarters]

Thank you 😀

[@Solterie1]

This is the problem with english nomenclature - for german/slav countries, everything to do with failure of bowel passage is an ileus, but we separate mechanical ileus and neurogennic ileus. Makes it much simples to understand.

[@Radquarters]

Good point RadPejrol, that does sound like a simpler approach.

[@mandalorian4620]

@@Radquarters
Yeah, I was really confused when you said it wasn't an ileus while (in german medical jargon) it obviously is lol

[@kishorkumarb3192]

Is there abdominal aortic aneurysm ? Or intentionally missed to stress more on gall stone ileus.

[@Radquarters]

Very observant, you are correct! I didn't mention it so as to focus on the gallstone ileus findings.

[@howdareu964]

Abnormal lab values that would correlate with this ?

[@Radquarters]

Lab values for gallstone ileus are often nonspecific. Some patients present with jaundice, abnormal LFTs or leukocytosis, but not consistently.

[@howdareu964]

@@Radquarters
much appreciated. excellent videos doc

[@howdareu964]

@@Radquarters
positive murphy sign, check

[@tahseenraza8596]

Great but use your natural voice more😂