Presentation
Sudden onset chest and abdominal pain with vomiting. Suspected aortic dissection/ acute abdomen.
Patient Data
CT demonstrate a round dense calculus in the ileum within the pelvis causing abrupt transition and upstream small bowel dilatation.
Another dense calculus is seen in the gall bladder which is collapsed with gas locules in the neck region as well as intra and extra-hepatic biliary tree (pneumobilia), suggesting cholecystoduodenal fistula.
Case Discussion
Gallstone ileus is a relatively rare complication of cholelithiasis and often requires surgical intervention. The clinicians should suspect gall stone ileus among other differentials of acute abdomen.
Many patients with gallstone ileus are elderly, have poor general condition and delayed diagnosis that leads to dehydration, shock, sepsis, or peritonitis.
This case highlights the fact that even if there is a stone present in the gall bladder, there may be another one, causing all problems!
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