Library

Case of the Month – February 2020

By Dr Bradley Wray

History:

Patient presented to emergency with abdominal pain – ? diverticulitis ? bowel obstruction

Imaging:

Investigation with a CXR assessing for pneumoperitoneum associated with a perforation and a CT abdomen/pelvis.

Findings:

The CT demonstrated a 31mm gallstone lodged in the small bowel associated with dilated loops of small bowel proximally in keeping with a small bowel obstruction. Gas in the gallbladder and biliary tree with a communication with the duodenum is consistent with a biliary-enteric fistula. There is a small volume of reactive free fluid in the abdomen but no signs of ischemia or perforation. Features are in keeping with a gallstone ileus.

Summary:

Gallstone ileus is a rare but important cause of a mechanical small bowel obstruction. Repeated bouts of cholecystitis results in the formation of a fistula between the gallbladder and the adjacent bowel, commonly the duodenum or colon. If a gallstone is present, this can migrate through the fistula into the small bowel and eventually lodge in the bowel, causing a small bowel obstruction.

Treatment is usually surgical, involving removal of the stone (an enterolithotomy), removal of the gallbladder and repair of the fistula.

Send Enquiry

Search

Type your search in below

Download information pack as a PDF

Download