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Abstract
Gallstone ileus is a rare cause of bowel obstruction, which mainly affects the elderly population. The associated mortality is estimated to be up to 30%. The presentation of gallstone ileus is notoriously non-specific, and this often contributes to the delay in diagnosis. The diagnosis of gallstone ileus relies on a radiological approach, and herein we discuss the benefits and drawbacks of the use of different modalities of radiological imaging: plain abdominal films, computed tomography, magnetic resonance imaging, and ultrasound scanning. Based on our case experience and review of the literature, the authors conclude that although an effective first-line tool, plain abdominal films are not adequate for diagnosing gallstone ileus. In fact, the gold standard in an acutely unwell patient is computed tomography.
Highlights
Gallstone disease affects approximately 15% of the population of the UK, often an asymptomatic disease [1]
Gallstone Bileus^ itself is a misnomer as the underlying pathology is that of mechanical obstruction of the bowel by a gallstone rather than a paralytic ileus as the name suggests
Gallstone ileus accounts for 1–4% of all causes of mechanical bowel obstruction, or up to 25% of all bowel obstruction in the population > 65 years of age [3]
Summary
Gallstone disease affects approximately 15% of the population of the UK, often an asymptomatic disease [1]. The sensitivity of AXR for the diagnosis of gallstone ileus is between 40 and 70% [3, 46, 48], and its positive predictive value approaches 80% in patients with high-grade intestinal obstruction Rigler described his famous triad of radiological signs in 1941 for gallstone ileus on plain film: air within the biliary tree (pneumobilia), signs of small bowel obstruction, and ectopic radio-opaque gallstones [49]. A study by Barakos et al reports several cases of isoattenuating tones relative to the fluid, which has accumulated in obstructed bowel These stones were missed on CT but were later demonstrated by ultrasound scanning or postoperatively [59]. Bowel obstruction Pneumobilia Ectopic gallstone Rigler’s triad Bilioenteric fistula
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