Diagnosis Of Gallstone Ileus Research Articles

A little goes a long way: A comparison of enterolithotomy versus single-stage cholecystectomy in the management of gallstone ileus

INTRODUCTION Gallstone ileus is an infrequent complication of cholelithiasis with no specific guidelines for its management. This study aims to compare the outcomes of patients with gallstone ileus managed with both enterolithotomy with cholecystectomy (EL-CCY) versus those managed with enterolithotomy (EL) only. METHODS In this retrospective analysis of 2011–2017 Nationwide Readmissions Database, all patients with an index admission diagnosis of gallstone ileus were included. Patients were stratified based on the type of intervention received for gallstone ileus into those who underwent EL-CCY and those who underwent EL alone and compared. Primary outcomes were in-hospital complications (surgical site infections, sepsis, pneumonia, cardiac arrest, deep vein thrombosis, intestinal obstruction) and mortality. Secondary outcomes were hospital length of stay, hospital costs, and readmissions rate and cause of readmissions. Multivariable logistic regression analysis was performed. RESULTS A total of 1,960 patients were identified. The mean age was 67 years and 67% were female. Two hundred eighty-nine patients (14.7%) were managed with EL-CCY, whereas 1,671 patients (85.3%) underwent EL only. Overall, the readmission rate was 4.8%, whereas mortality was 4.2%. There was no significant difference between groups in terms of index-admission complications (24.8% vs. 21.7%, p = 0.415), mortality (6.2% vs. 3.9%, p = 0.068), rates of readmission (3.5% vs. 5.1%, p = 0.22), and cause of readmission (p > 0.05). Enterolithotomy and cholecystectomy group had significantly longer hospital length of stay (10 vs. 8 days, p < 0.001) and median hospital costs ($70,959 vs. $52,147, p < 0.001). On multivariable logistic regression analysis, female sex was a predictor of undergoing EL-CCY, whereas increasing age and higher grade of all-patient redefined diagnosis-related groups risk of mortality were independently associated with lower odds of undergoing EL-CCY. CONCLUSION Our findings suggest no difference between EL compared with EL-CCY in terms of complications, readmissions, and mortality. However, patients managed with EL-CCY had a longer hospital stay and higher hospital costs compared with EL. Further prospective studies are needed to validate these findings and develop management protocols for gallstone ileus. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.

The Gallstone Ileus, a Retrospective Study and Review of the Literature

Introduction: Gallstone ileus (GI) is a rare complication of cholelithiasis and is one of the most irregular forms of all mechanical bowel obstructions. It is, however, a more common cause of non-strangulating mechanical small bowel obstruction, accounting for 1% to 4% of all patients and up to 25% in the elderly.
 The diagnosis is often delayed since symptoms may be intermittent, and investigations may fail to identify the cause of the obstruction. As a result, gallstone ileus continues to be associated with relatively high rates of morbidity and mortality.
 The cornerstone of healing is the removal of the stone that represents obstruction. As is the case with cholelithiasis, women are more frequently affected.
 Material and Methods: This article aims to review the incidence of gallstone ileus in our country in the literature, addressing the pathophysiology, clinical presentation, radiological findings, and treatment options. A literature search was done on gallstone ileus for 2005-2018.
 Results: The patients in the study presentation were both genders and older. They all came to INP because of abdominal pain and general nausea. All had CRP elevation present. Leukocytosis was present in only 2/3 of patients. AST was elevated in one patient and ALT in 2. All changes in laboratory parameters indicate the instability of marker changes and, consequently, the unreliability of use alone without other diagnostic methods. A CT scan was performed on all three patients, but one still needed to be uploaded to the system at the time of writing.
 Conclusions: Ileus due to gallstones is a rare disease. It is an uncommon cause of mechanical small bowel obstruction. It is a rare complication of chronic cholecystitis and occurs when a gallstone passes through a fistula between the gallbladder and small bowel before becoming impacted at the ileocecal valve. The use of radiological imaging is invaluable in the diagnosis of gallstone ileus. These authors recommend a low threshold for investigation. There is evidence for using AXR as a quick first-line investigation; however, CT scanning is a powerful and gold-standard tool to diagnose the condition and guide its management.

Gallstoneileus: A Rare Cause of Smallbowel Obstruction

Biliary ileus is a rare complication of gallstones secondary to a bilio-digestive fistula with passage of a macro calculus in the small intestine and which may be responsible for intestinal obstruction. Its misleading symptomatology often leads to diagnostic delay which worsens the prognosis. Computed tomography is the main imaging modality for diagnosis of gallstone ileus. We report the case of a 63-year-old patient presenting vomiting with diffuse abdominal pain and inability to pass gas or stool evolving for 3 days. Abdominal computed tomography revealed moderate aerobilia, an atrophic gallbladder with air bubbles associated with small bowel obstruction due to a jejunal calculus. Laparotomy revealed the presence of a cholecystoduodenal fistula, a sclero-atrophic gallbladder with the presence of a stone obstructing the lumen in the jejunum; an enterolithotomy was performed with a cholecystectomy and closure of the fistula path in a single operative step; the postoperative outcome werefavorable.

Gallstone Ileus in the Absence of Gallbladder, Rare Etiology of Bowel Obstruction: A Case Report and Literature Review

Background: Gallstone ileus post-cholecystectomy is extremely rare surgical emergency causing mechanical bowel obstruction. This condition is usually misdiagnosed due to its non-specific clinical features. Radiological investigations are essential to evaluate and diagnose gallstone ileus cases. Case Presentation: A 92-year-old female patient, cholecystomized, presented to our hospital with a one-week history of an acute confusional state, generalized abdominal pain, and vomiting. The physical examination showed a disoriented patient with a distended abdomen and generalized tenderness, especially in the epigastric area. Hyperactive bowel sounds were audible. Laboratory investigations were non-specific. A plain abdominal X-ray was insignificant. The abdominal ultrasound showed marked abdominal gaseous distention. Then, an abdominal CT scan was performed, revealing an impression of gallstone ileus causing small bowel obstruction with no evidence of fistula formation. So, surgical intervention was decided, and an 8-gram gallstone was exteriorized through an enterolithotomy. The postoperative period was uneventful. Discussion: Gallstone ileus is an unusual entity that often affects elderly females. The clinical features of gallstone ileus include abdominal pain, abdominal distension, nausea, and vomiting. Diagnosis of gallstone ileus relies on imaging and physical examination. Abdominal CT with contrast provides a definitive diagnostic tool. The surgical options to manage the gallstone ileus can be either one or two-staged enterolithotomy. Conclusion: Due to the rare etiologic origin of the gallstone ileus in post-cholecystectomy cases, we report the case of a 92-year-old female with an acute confusional state and generalized abdominal pain, found to be caused by detected gallstone ileus, lacking evidence of fistula formation.

S362 Endoscopic Holmium Laser Lithotripsy for Therapy of Bouveret Syndrome

Introduction: Bouveret syndrome is a rare condition characterized by the impaction of a gallstone in the stomach or duodenum via a fistulous tract resulting in gastric outlet obstruction. This condition generally requires surgery to remove the impacted stone. However, for patients who are unable to undergo surgery, laser lithotripsy can be an alternative therapy. Here, we present an interesting case of a patient with recurrent gallstone ileus successfully treated by endoscopic Holmium laser lithotripsy Case Description/Methods: A frail 79-year-old woman with chronic cholecystitis presented with right upper quadrant abdominal pain. Abdominal computed tomography (CT) scan demonstrated emphysematous calculous cholecystitis, a cholecystoduodenal fistula and a 30 mm gallstone lodged in the terminal ileum. She emergently underwent an ileocecal resection and partial right colectomy, confirming the diagnosis of gallstone ileus and a small bowel perforation. 10 days post-surgically, the patient again developed nausea, vomiting, and right upper quadrant pain. CT imaging re-demonstrated a 40 mm gallstone within the gallbladder fossa, Surgical options were limited due to a friable duodenum and inflammation of the cholecystoduodenal fistula. After a multidisciplinary discussion, endoscopic therapy was planned. Endoscopically, a large gallstone measuring about 40 mm was into the duodenal bulb eroding into the duodenum consistent with the known fistula. Holmium laser lithotripsy was used to fragment the stone. Due to the size of the gallstone, the procedure was performed in two sessions. During the first session, the stone was successfully fractured into smaller fragments. In the subsequent session, the remaining gallstone measuring about 28 mm was fragmented until the fistula tract was cleared. The larger gallstone fragments were removed using a roth net and a stone retrieval basket. Full resolution of the Bouveret syndrome was achieved. No immediate or delayed complications were noted. The patient is now doing well 3 months post-procedurally. (Figure) Discussion: Although surgery is often required for definitive therapy of Bouveret syndrome , endoscopic management remains a feasible option in select cases with appropriate expertise. Here, we present a case of successful endoscopic therapy utilizing Holmium laser lithotripsy in a high-risk patient for Bouveret syndrome. Although utilizing this technique is lengthy and requires advanced endoscopic expertise, provides a great benefit due to its minimal tissue injury and safety. Watch the video at https://tinyurl.com/ACGAbstractS362Figure 1.: A) Cholecystoduedenal fistula on CT scan, B) Holmium laser lithotripsy for Bouveret syndrome.

Gallstone ileus diagnosis and treatment: six-year experience in three academic institutions

Gallstone ileus diagnosis and treatment: six-year experience in three academic institutions

Gallstone ileus: Rare Entity for Mechanical Small Bowel Obstruction

Gallstone ileus is common in elderly female population. To obtain a diagnosis of gallstone ileus is a challenge requiring clinical and radiological assistance. It’s a rare cause of intestinal obstruction, accounts approximately 1-4%. Here we report a case of 56 years old lady presented with intestinal obstruction sign and symptoms. Per abdomen examination revealed generalised tenderness with sluggish bowel sound. Abdominal X-ray revealed prominent small bowel with presence of gas till rectum. CT abdomen noted intraluminal mass over distal small bowel loops mimickering intusseption. Exploratory laparotomy with small bowel enterotomy was performed. Intra-operative finding noted impacted gallstone measuring 2x3cm, 360cm from duodenal-jejunal flexure and 50cm from terminal ileum. Post-operative patient had speedy recovery and discharged home. Here we emphasize in elderly female patient presented with sign and symptoms of intestinal obstruction, diagnosis of gallstone ileus should be one of differential diagnosis.

Gallstone ileus after hepaticojejunostomy in liver transplant recipient: case report

Presenter: Patricio Vanerio MD | Hospital Central de las Fuerzas Armadas Background: Gallstone ileus is an infrequent cause of mechanical bowel obstruction. It is caused by transition of a gallstone in the gastrointestinal tract usually through a biliary-enteric fistula, occurring in 1 to 3% of all cases of mechanical bowel obstruction. In patients with a hepaticojejunostomy gallstones can be formed at the proximal side of it and then pass through the lumen. In this cases hepatolithiasis is associated with recurrent anastomotic stricture and cholangitis. Even though abdomen computed tomography (CT) is very informative for diagnosis of gallstone ileus, it is oftenly found during laparotomy performed for unexplained small bowel obstruction. We present the case of a patient who was admitted with a gallstone ileus, in whom the gallstone stone was formed at the hepaticojejunostomy (liver transplant recipient) and entrapped at afferent loop of the Roux-en-Y jejunojejunostomy. Methods: We present the case of a 22yo female. Heretopic reduced liver recipient 20 years ago because of biliary atresia. Admitted 2 years ago with a mild cholangitis, MRCP demonstrated stenosis of hepaticojejunostomy associated with hepatolithiasis. Treatment consisted in percutaneous dilation of bilioenteric anastomosis and progression of litiasis to jejunum. No complications or symptoms were registered during follow up in the next 2 years. Begun with sudden intermittent colicky abdominal pain, nausea, and vomiting. Computed tomography (CT) evidenced small intestine dilation associated with 2 hyperdense structures of about 30 and 40mm as cause of obstruction (figure). Mild intraabdominal fluid, no large intestine dilation, no other pathological findings. Exploratory laparotomy was performed, extensive adhesiolysis, dilation of roux en Y afferent loop, a gallstone of 40mm was the cause of obstruction. A second gallstone was found distally. Enterotomy with gallstone removal was performed. Postoperative occurred without incidents. Patient was discharged at day 3. Results: Intestinal obstruction has many causes, gallstone ileus is infrequent and usually secondary to cholecystoduodenal fistula which is corresponds to an abnormal communication between the gallbladder and the duodenum that occurs as a rare complication of an untreated gallstones. Other cause of gallstone ileus is hepatolihtiasis formed over a pathologic hepaticojejunostomy with anastomotic stricture and recurrent cholangitis. In this cases, the usual complication is a cholangitis secondary to the obstruction and infection of the bile duct. Percutaneous approach consists in stricture dilation and extraction and/or progression of lithiasis, surgery is a more aggressive and morbid approach which consists in hepaticojejunostomy re do. In our patient gallstone ileus was caused by gallstones advanced during percutaneous treatment 2 years before. Clinical and radiological manifestations of small bowel obstruction do not differ. Neither does surgical treatment, in which laparotomy is the most common approach and enterotomy with gallstone extraction is indicated. Conclusion: We present an extremely rare case of gallstone ileus due to hepatolithiasis caused by stricture of hepaticojejunostomy in a liver transplant recipient. Percutaneous treatment was performed to treat bilioenteric stricture, however this procedure progressed lithiasis distally into jejunal loop causing a small bowel obstruction 2 years later.

Cholecystoduodenal Fistula Causing Gallstone Ileus

Gallstone ileus is a rare disease, and it accounts for 1–4% of all cases of mechanical intestinal obstruction. Incidence is more in elderly with a female predominance and may result in a high mortality rate. The diagnosis of gallstone ileus is difficult, and early diagnosis could reduce the mortality. Surgery is the mainstay of treatment. Here, we are reporting a case of 65-year-old lady presented as intestinal obstruction and later diagnosed to have cholecystoduodenal fistula causing gallstone ileus.

Rolling in the Deep: Imaging Findings and Diagnostic Pearls in Gallstone Ileus.

Gallstone ileus is a dramatic complication of gallstone disease, uncommon but not exceptional in a busy emergency department. It represents a cause of mechanical intestinal obstruction, which predominantly occurs in elderly and frail patients; this contributes to the high morbidity and mortality rates associated with this condition. The modern radiologist is frequently asked to determine the cause of bowel obstruction and should be aware of the most pictorial features of this unusual disease. Broadly speaking, abdominal radiography and ultrasonography alone are limited in detecting the cause of bowel obstruction, but the sensitivity for the preoperative diagnosis of gallstone ileus may be improved by combining the findings obtained by both techniques. Computed tomography is the modality of choice for the diagnosis of this disease: it may accurately describe the number, size, and location of migrated gallstones and the exact site of bowel obstruction, providing a detailed preoperative planning. Magnetic resonance imaging may be used in selected cases for an exquisite anatomic definition of the fistulous communication.

Evaluation and diagnosis of gallstone ileus using point of care ultrasound in the Emergency Department

A 75-year-old female presented to the Emergency Department (ED) with nausea, feculent emesis and abdominal distension. On previous visit the patient was diagnosed with a 2.2x1.9x1.1 cm ectopic gallstone in the mid small bowel without evidence of ileus or bowel obstruction and was subsequently discharged home. She returned 2 days later, abdominal plain radiographs revealed mildly dilated small bowel with air-fluid levels and a calcified mass in the right hemipelvis. Bedside ultrasound was performed and an air filled gallbladder with a fistulous tract was visualized. Dilated loops of bowel were visualized with an abnormal back and forth movement of intestinal contents, consistent with a small bowel obstruction. Patient went on to have an uncomplicated surgical extraction of the gallstone with resolution of her ileus. We would propose using point-of-care ultrasonography with abdominal plain films as an adjunct for evaluation and diagnosis of gallstone ileus in elderly patients.

New in the problem gallstone bowel obstruction

Aim. To identify the frequency of gallstone ileus based on the surgical experience of the Kiev region in patients with acute calculous cholecystitis and acute intestinal obstruction. To evaluate the capabilities of the gallstone ileus diagnosis algorithm for correct topical diagnosis before surgery.Materials and methods. For 2004–2018, 13713 patients with acute cholecystitis and 3609 patients with acute intestinal obstruction were hospitalized. In 0.64% of cases, gallstone ileus was diagnosed in patients with acute calculous cholecystitis, in 0.41% in choledocholithiasis, and in 2.4% in its complex forms. In 0.73% gallstone ileus was detected during operations for acute intestinal obstruction and in 1.12% for its obstructive form.Results. A total of 25 patients with gallstone intestinal obstruction underwent surgery. In the topical diagnosis of gallstone intestinal obstruction, X-ray contrast methods dominate. During surgical procedure, only with pyloroduodenal variants of obstruction, cholecystectomy is performed simultaneously with the elimination of obstruction. In other situations, cholecystectomy is performed after 3–8 months. Of the 25 patients, 4 patients died due to ascending cholangitis, peritonitis due to bile leakage, and severe co-morbidities.Conclusion. The use of the algorithm of advanced diagnostic methods allows you to receive a diagnosis in most patients. The most valuable in topical diagnostics are contrast methods. New in gallstone ileus is the migration of gallstone after endoscopic papillosphincterotomy with mechanical lithotripsy for choledocholithiasis, especially with its complex forms. In our opinion, all types of gallstone ileus can be combined into Bartolin-Bouveret syndrome, which first described this variant of mechanical intestinal obstruction.

Non-typical gallstone ileus: case report

Gallstone ileus (GI) is a complication of gallstone disease causing mechanical intestinal obstruction due to impaction of gallstone in the gastrointestinal tract. It accounts for less than 1-4% of the cases. It is more common among elderly female. Nowadays diagnosis of GI became more reliable and easier using radiological modalities such as abdominal CT/MRI scanning although still the mortality and morbidity considered to be high in such diagnosis. This is a case of gallstone ileus in a 73-year-old woman. Initially, plain X-ray showed signs of intestinal obstruction with large radiopaque shadows seen in right upper and lower quadrant of the abdomen. The diagnosis was made by MDCT scan which showed unfamiliar findings that are: unusual stone location that impacted in the jejunum, incomplete Rigler's triad as there was no pneumobilia and a 2.6 cm ectopic stone that appeared to be larger postoperatively. Patient underwent urgent laparotomy with enterotomy where a 4 cm gallstone was removed and intraoperative exploration for the rest of the bowel revealed another stone in the sigmoid colon that was initially detected by MDCT which milked toward the rectum. Post-operative course was uneventful. Abdominal X-ray can be used a preliminary tool for intestinal obstruction in general. Although abdominal CT scan is the investigation of choice to diagnose gallstone ileus, accurate size and number still under debate. Pneumobilia is not a common finding and Rigler’s triad advised to be revised. Intraoperative exploration is necessary to rule out other stones.

Gallstone Ileus: An Uncommon Cause of Acute Abdomen

Gallstone ileus is a rare cause of acute abdomen, representing less than 1% of intestinal obstruction. It is due to mechanical small bowel obstruction (SBO) by a migrated gallstone. we report this observation to illustrate the imaging findings especially in CT scan. A 62-year-old woman was admitted to emergency for acute bowel obstruction. The CT scan has confirmed jejunal bowel distension with fluid levels upstream endoluminal formation which was rounded and well limited, measuring 5 cm of long axis. This training was slightly hyperdense with hypodense areas of fat density. Moreover, there was aerobilia with multiple fistulas between the duodenum (D1) and gallbladder, which was empty. The triad of aerobilia, small bowel obstruction and migrant gallstone was suggestive of gallstone ileus diagnosis. The patient was operated with good evolution. Gallstone ileus is an uncommon presentation of gallstone disease. It is frequently observed in elderly patients with a history of cholelithiasis or cholecystitis. Early diagnosis is crucial and would avoid morbidity and mortality related to this disease. CT scan shows the classical triad of Rigler with pneumobilia, an ectopic stone and mechanical ileus. CT may improve the diagnosis providing important information regarding the exact number, size, and location of ectopic stones and the site of intestinal obstruction or direct visualization of a biliary–enteric fistula, to help clinicians in the therapeutic management of patients.

Gallstone Ileus : Case Report of a Rare Cause of Intestinal Obstruction in an Unexpected Age Group

Background: gallstone ileus is a rare complication of cholelithiasis and considered as a type of mechanical bowel obstruction in which a gallstone is impacted in the gastrointestinal tract. This condition is seen more frequently in old patients with females’ predominance. Gallstone ileus is responsible for 1%-5% of mechanical intestinal obstruction. Case presentation: we report a case of 48 years old medically free, male patient presented to Emergency Department with severe abdominal pain, distention, constipation, multiple attacks of vomiting associated with nausea and with a chronic history of cholecystitis. The diagnosis of gallstone ileus was confirmed by abdominal X-ray and abdominal computed tomography (CT) scan findings. The patient was stabilized before doing an exploratory laparotomy. Conclusion: gallstone ileus is an emergency condition associated with high morbidity and mortality rates. To get the most favorable outcome, high clinical suspicion aided by the use of diagnostic modalities such as CT abdomen is needed to reach the diagnosis since it is usually present with nonspecific signs and symptoms.

Gallstone Ileus Caused by a Cholecysto-Duodeno-Colic Fistula, Case Report And Literature Review

Abstract Introduction: Complex cholecysto-duodeno-colic fistulas are an extremely rare complication that can occur in patients with cholelithiasis. The aim of this article is to present the case of a pacient with cholecystoduodeno- colic fistula manifested with biliary ileus in a patient known for many years with cholelithiasis. Case report: We present the case of a 62 y/o male that was admitted in our clinic with the diagnosis of gallstone ileus. Emergency surgical intervention was needed. Intraoperatively we discovered a cholecysto-duodenocolic fistula complicated with gallstone ileus. During the operation we practiced retrograde cholecystectomy, closure of the fistulous tract (duodenoraphy, coloraphy), enterotomy and extraction of the calculus located inside the small intestine. The postoperative evolution was favorable. Conclusions: Cholecysto-duodeno-colic fistulas complicated with gallstone ileus are an extremely rare complication that can occur in patients with gallstones. In case of the occurrence of gallstone ileus, the surgical treatment is an emergency, being the only therapeutic technique that can save the patient’s life.

Clinical and radiological diagnosis of gallstone ileus: a mini review

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.

Gallstone ileus: An overview of the literature.

Gallstone ileus represents 4% of the causes of bowel obstruction in the general population, but increases to 25% in patients above the age of 65 years. Gallstone ileus does not present with unique symptoms, making diagnosis difficult. Its management is surgical, but there is no consensus as to which of the different surgical techniques is the procedure of choice. At present, there is no recent review of this pathology. To conduct an up-to-date review of this disease. Articles published within the time frame of 2000 to 2014 were found utilizing the PUBMED, EMBASE, and Cochrane Library search engines with the terms "gallstone ileus" plus "review" and the following filters: "review", "full text", and "humans". The results of this review showed that gallstone ileus etiology was due to intestinal obstruction from a gallstone that migrated into the intestinal lumen through a bilioenteric fistula. The presence of 2 of the 3 Rigler's triad signs was considered diagnostic. Abdominal tomography was the imaging study of choice for gallstone ileus diagnosis and the surgical procedures for management were enterolithotomy, one-stage surgery, and two-stage surgery. Enterolithotomy had lower morbidity and mortality than the other 2 procedures. The aim of gallstone ileus treatment is to release the obstruction, which is done through enterolithotomy. It is the recommended technique for gallstone ileus management because of its lower morbidity and mortality, compared with the other techniques.

Gallstone ileus: An overview of the literature

IntroductionGallstone ileus represents 4% of the causes of bowel obstruction in the general population, but increases to 25% in patients above the age of 65 years. Gallstone ileus does not present with unique symptoms, making diagnosis difficult. Its management is surgical, but there is no consensus as to which of the different surgical techniques is the procedure of choice. At present, there is no recent review of this pathology. AimTo conduct an up-to-date review of this disease. Materials and methodsArticles published within the time frame of 2000 to 2014 were found utilizing the PUBMED, EMBASE, and Cochrane Library search engines with the terms “gallstone ileus” plus “review” and the following filters: “review”, “full text”, and “humans”. ResultsThe results of this review showed that gallstone ileus etiology was due to intestinal obstruction from a gallstone that migrated into the intestinal lumen through a bilioenteric fistula. The presence of 2 of the 3 Rigler's triad signs was considered diagnostic. Abdominal tomography was the imaging study of choice for gallstone ileus diagnosis and the surgical procedures for management were enterolithotomy, one-stage surgery, and two-stage surgery. Enterolithotomy had lower morbidity and mortality than the other 2 procedures. ConclusionsThe aim of gallstone ileus treatment is to release the obstruction, which is done through enterolithotomy. It is the recommended technique for gallstone ileus management because of its lower morbidity and mortality, compared with the other techniques.

Pictorial review: the pearls and pitfalls of the radiological manifestations of gallstone ileus.

We present a pictorial review of a range of typical and atypical cases of gallstone ileus (GI), across a wide range of imaging modalities. GI is a complication of gallstone disease causing mechanical intestinal obstruction due to impaction of gallstone in the gastrointestinal tract. The spectrum of presentation can vary enormously, and we highlight the importance of accurate imaging diagnosis of GI especially early use of computed tomography. This will lead to timely and appropriate surgical intervention with the potential avoidance of unnecessary outcomes. The ambition of pictorial synopsis is to make the radiologists to be more vigilant to the common and more obscure imaging findings of GI.