Gallstone ileus

Excerpt

A 60-year-old man with a history of gallstones (Fig. 1A) suddenly developed severe abdominal pain that lasted approximately 10 h. The abdominal pain was associated with nausea and vomiting. A physical examination revealed diffuse abdominal tenderness and rebound pain with no palpable masses. An abdominal computed tomography (Fig. 1B) did not reveal any gallstones, however, there was a calcified mass with proximal dilatation in the small intestine (Fig. 1C). Air was present in the biliary tree (Fig. 1D). Rigler’s triad, comprising an ectopic gallstone, small-bowel obstruction, and air in the biliary tree, is indicative of cholecystoenteric fistula and gallstone ileus (GI). The patient received treatment in the form of cholecystectomy, removal of gallstone from the jejunum, and closure of cholecystoenteric fistula. On the tenth day following the surgical procedure, upper gastrointestinal contrast radiographs were conducted utilizing iodine, which revealed the presence of a partially patent duodenal fistula (Fig. 1E). The patient did not undergo a subsequent surgical intervention. After the one-month post-operative period, an upper gastrointestinal contrast radiograph was performed, revealing successful closure of the fistula.

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