Learning objectives
To check the main radiological findings with different imaging tests of gallstone ileus that all radiologists should know.
Background
Gallstone ileus is an uncommon cause of mechanical bowel obstruction.
However,
it is associated with high morbidity and mortality (8-30%) [1-3],
and usually affects elderly patients,
who often had other concomitant medical-surgical diseases.
It is crucial an early and precise preoperative diagnosis,
where different imaging tests play an important role.
We will review the most important aspects of this entity,
particularly the main radiological findings,
and illustrate it with a series of 5 cases of our center.
PATHOGENESIS
The gallstone ileus is defined as the...
Imaging findings OR Procedure details
Gallstone ileus is an entity of complex diagnosis.
A better understanding of this condition allows a more precise diagnosis and early treatment,
essential in these patients.
Thus it is important to know the main radiological findings in the different imaging techniques (plain radiography,
ultrasound and CT).
Plain abdominal films
Findings suspicious of a gallstone ileus are:
Demonstration of the classic Rigler’s triad (Figure 1),
pathognomonic of gallstone ileus [7,
9] (two of our five patients).
It is characterized by:
Air in the biliary tree (pneumobilia)...
Conclusion
Gallstone ileus is an important but rare cause of mechanical bowel obstruction that we should suspect in elderly patients,
mainly women,
with previous biliary illness.
Early diagnosis is essential because its high morbidity and mortality,
emphasizing the role of imaging techniques,
particularly CT,
which also helps in the therapeutic approach focused on solving the obstruction.
References
1.
A.
Azagra,
B.
Carro,
E.
M.
Lacoma,
R.
Domene,
J.
A.
Fernandez,
L.
J.
Villavieja.
Gallstone ileus: An uncommon cause of mechanical obstruction.
10.1594/ecr2010/C-1456
2.
L.
Piccolo.
Role of MSCT in the diagnosis of gallstone ileus.
10.1594/ecr2012/C-0238.
3.
Lassandro F,
Romano S,
Ragozzino A,
Rossi G,
et al.
Role of helical CT in diagnosis of gallstone ileus and related conditions.
AJR Am J Roentgenol.
2005 ;185(5):1159-65.
4.
Andrew P Keaveny,
Nezam H Afdhal,
Steven Bowers.
Gallstone ileus.
http://www.uptodate.com/
5.
Dähnert,
Wolfgang.
Radiology Review Manual....