CLINICAL UTILITY OF RADIOLOGICAL IMAGING IN THE EVALUATION OF GALLSTONE ILEUS

Abstract

Objective: Gallstone ileus is a rare complication of cholelithiasis. It occurs as a result of the passage of bile stones into intestinal system via bilioenteric fistulae, which are formed by recurrent attacks of cholecystitis, and obstruction of the intestinal lumen. The objective of our study was to discuss the imaging findings of gallstone ileus among patients diagnosed at our center.Material and Methods: Among patients that admitted to our hospital’s radiology department between December 2016 and January 2019, the medical records of those with a history of gall bladder stone detected on ultrasonography were retrospectively evaluated. Among those, cases of gallstone ileus were identified. Admission complaints, age, sex, comorbidities, radiological imaging findings, fistula localization, stone size, and obstruction level were recorded and analyzed.Results: Among 958 patients with bile stones, 342 (35.7%) were male and 616 (64.3%) were female. Gallstone ileus was identified in five patients. Three of them were female (mean age 76.67± 13.05 years) and 2 were male (mean age 59±1.41 years). Ileus signs were detected on plain radiograms for all patients. The gallbladders were not clearly visualized by ultrasonography in any of patients with gallstone ileus. A diameter increase suggestive of ileus was detected in visualizable intestinal segments. Computed tomography to identify the cause of ileus revealed air in the bile ducts, cholecystoduodenal fistula, stones in intestinal lumen, and an appearance consistent with ileus proximal to that segment. The mean size of the stones was 26.20±16.3 mm (16-55 mm).Conclusion: Although gallstone ileus is a rare cause of intestinal obstruction, it should be definitely remembered in the differential diagnosis in patients with advanced age and a history of cholelithiasis who present to the emergency department.