Gallstone Ileus

Published on 05/08/2015 by admin

Filed under Radiology

Last modified 05/08/2015

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 Rigler triad of small bowel (SB) obstruction, gas in biliary tree, and ectopic gallstone

• Location: Points of luminal narrowing of bowel; duodenum, ligament of Treitz, ileocecal valve, sigmoid colon
• CT findings

image Gallstone surrounded by gas in bowel loop

– Cholesterol stones near-water density, often with calcified rim
image Collapsed gallbladder, pneumobilia (gas within GB ± bile duct lumen)
image Dilated bowel with transition to collapsed bowel at impacted gallstone

TOP DIFFERENTIAL DIAGNOSES

• Intussusception
• Dropped gallstone (intraperitoneal, not intraluminal)

PATHOLOGY

• Occurs with chronic cholecystitis
• Delayed (up to 2 months) complication of ERCP
• Diagnosis frequently delayed or missed

CLINICAL ISSUES

• Most common signs/symptoms: Intermittent acute colicky abdominal pain (20-30%), nausea, vomiting, fever, distension, obstipation
• Gallstone erodes inflamed GB wall, passes into GI tract (usually duodenum) → bowel obstruction

DIAGNOSTIC CHECKLIST

• Consider in elderly woman with recurrent RUQ pain, recently more severe and prolonged vomiting
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