Abstract
Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case, we discuss a difficult diagnostic case of gallstone ileus with a non-calcified gallstone. An 88-year-old female presented with abdominal pain and vomiting. A CT scan was arranged and showed an evolving bowel obstruction although no frank hyperdensity suggestive of a gallstone was noted. Initially the cause of the bowel obstruction was uncertain, but after discussion with the treating team and further review of the images, the patient was diagnosed with gallstone ileus. The patient underwent emergency surgery and a 41 mm obstructing calculus was removed from the patient’s jejunum, later confirmed on histological diagnosis.
Highlights
Gallstone ileus is a rare complication of choleliathiasis
The CT scan was reported as showing features of a bowel obstruction with a transition point in the left iliac fossa
An addendum was added to the CT report, suggesting that the appearances were indicative of a gallstone ileus from a choledochoduodenal fistula (Figure 2) with a non-calcified gallstone possibly being present at the transition point in the left iliac fossa (Figure 3)
Summary
Gallstone ileus is a rare complication of choleliathiasis. It has a propensity to affect females and the elderly, and accounts for under 0.5% of cases of mechanical small bowel obstruction.[1,2] It occurs as a gallstone enters the small bowel through a biliary enteric fistula, with more than half of these being cholecystoduodenal fistulas. Gallstone ileus presents as an episodic bowel obstruction with diffuse abdominal pain and vomiting. The CT scan was reported as showing features of a bowel obstruction with a transition point in the left iliac fossa.
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