Presentation
Diffuse abdominal pain, loss of appetite, bilious vomiting, bowels not opened for 5 days, including no flatus ?obstruction
Patient Data
There is significant image degradation due to motion, streak and beam hardening artifacts from the bilateral total hip replacement implants.
NG tube in the stomach.
Multiple dilated loops of small bowel. Transition point in distal ileum with decompressed small bowel distal to it. A large intraluminal, calcified mass is noted at this point. No free gas or fluid.
Inflamed gallbladder, inseparable from the adjacent duodenum. Mild intrahepatic biliary duct dilatation with pneumobilia.
Colonic diverticulosis. Incidental cystic lesion of the pancreas.
Otherwise, unremarkable appearances of imaged abdominopelvic viscera.
No enlarged lymph nodes.
No bone lesions.
Conclusion:
1. Small bowel obstruction secondary to gallstone ileus.
2. Cystic lesion of the pancreas, advise CT pancreas.
At operation, a large gallstone was found at the transition point of the small bowel.
Case Discussion
The finding of small bowel obstruction in an elderly patient with pneumobilia (aerobilia) should always raise the possibility in your mind of a gallstone ileus.
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