Gallstone ileus

Case contributed by Dr Desiré Ciske Havinga

Presentation

3-day history of abdominal pain and change in bowel habits.

Patient Data

Age: 90 years
Gender: Female
CT

Low density (80 HU) gallstone within the ileum with proximal small bowel dilatation.
Small gallstones within the gallbladder neck.

Pneumobilia within the cystic duct.

Fistula between the gall bladder and the first part of the duodenum (Cholecystoduodenal fistula). 

Incidental two well-circumscribed left breast masses. 

Case Discussion

Gallstone ileus is a rare cause of mechanical bowel obstruction with a high mortality rate of up to 30%. 
The diagnosis is radiological and CT is the gold standard for diagnosis. 
Rigler's triad is pathognomonic for gallstone ileus and may be identified on abdominal x-ray with a gallstone in the terminal ileum, pneumobilia and signs of small bowel obstruction; however not all gallstones are radio-opaque and CT is more sensitive for pneumobilia. 
In this case, findings of a low density gallstone and pneumobilia were only seen on CT.

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