Gallstone Ileus

·         Unusual complication of chronic cholecystitis

·         Impaction of gallstone in ileum after passing through a biliary-enteric fistula

·         60% are cholecystoduodenal fistulae; others are cholecystocolonic and cholecystogastric fistulae 

·         Average age of patient is 70 years old

·         Delay in diagnosis

o       Mortality of 15-20%

·         Rigler’s Triad

o       Pneumobilia

o       SBO

o       Impacted gallstone-usually in the terminal ileum at ileocecal valve

 
Gallstone Ileus. Two axial images from a contrast-enhanced CT of the abdomen show air in the gall bladder (red arrow) and air in the common bile duct (blue arrow) representing pneumobilia, the gallstone in the small bowel lumen (yellow arrow) and dilated and fluid-filled loops of small bowel from small bowel obstruction (green arrow) -- all of the components of a gallstone ileus

Thanks to Julie Gubernick, MD who submitted the case material