Clinical and radiological diagnosis of gallstone ileus: a mini review

Abstract

Gallstone ileus is a rare cause of bowel obstruction, which mainly affects the elderly population. The associated mortality is estimated to be up to 30%. The presentation of gallstone ileus is notoriously non-specific, and this often contributes to the delay in diagnosis. The diagnosis of gallstone ileus relies on a radiological approach, and herein we discuss the benefits and drawbacks of the use of different modalities of radiological imaging: plain abdominal films, computed tomography, magnetic resonance imaging, and ultrasound scanning. Based on our case experience and review of the literature, the authors conclude that although an effective first-line tool, plain abdominal films are not adequate for diagnosing gallstone ileus. In fact, the gold standard in an acutely unwell patient is computed tomography.

Keywords: Gallstone; Gallstone coleus; Pneumobilia; Rigler’s triad; Small bowel obstruction.

Fig. 1

Plain abdominal film at time of admission. Poor quality plain abdominal radiograph obtained in the Emergency Unit, with only part of the abdomen examined. Note the foreign body in the left lower abdomen (ectopic gallstone), with left-sided loops of dilated small bowel. Nil convincing pneumobilia

Fig. 2

Contrast CT abdomen/pelvis images at time of admission. a CT slice demonstrating a dilated, fluid-filled stomach. Nil significant pneumobilia noted. b, c CT slices demonstrating an obstructing, calcified mid-jejunal intraluminal stone measuring 3 cm in diameter. Evidence of small bowel obstruction noted with dilated jejunal loops above the obstruction. Colon is of normal caliber