Gallstone ileus: key points every radiologist should know.

Congress:

ECR 2018

Poster Number:

C-1546

Type:

Educational Exhibit

Keywords:

Obstruction / Occlusion, Acute, Diagnostic procedure, CT, Conventional radiography, Gastrointestinal tract, Emergency, Abdomen

Authors:

J. P. Zawaideh¹, S. Banderali², L. Bacigalupo², G. A. Rollandi²; ¹Genova/IT, ²Genoa/IT

DOI:

10.1594/ecr2018/C-1546

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-1546

Fig. 1: Patient 1: X-ray AP view of the abdomen: the film shows the dilatation of bowel...

Fig. 2: Patient 1: CT Coronal reconstruction: The gallstone (Orange Arrow), impacted in...

Fig. 3: Patient 2: CT Coronal reconstruction: In this case the gallstone (Orange Arrow)...

Fig. 4: Patient 3: CT coronal MIP reconstruction: Most of the gallstone are not...

Learning objectives

The purpose of this presentation is to analyse the pathology, symptoms and out-comes of gallstone ileus. Focusing on the importance of accurate imaging diagnosis especially with CT.

Background

Gallstone ileus (GI) is an infrequent complication of cholelithiasis and is defined as mechanical intestinal obstruction due the impaction of gallstone in the gastrointestinal tract. This entity occurs in 0.3%-0.5% of patients with cholelithiasis. It predominantly affects the elderly patient population.1 Despite the rare incidence, it carries a mortality and morbidity rate of around 7–30% . Gallstones inflammation of the gallbladder wall causes erosion and leads to a fistula with the duodenum, which is the exit route for the stones. Less commonly, a gallstone may...

Findings and procedure details

Plain abdominal film is still often used as the first imaging modality for acute abdomen. Fig. 1 It is possible to observe the Rigler’s triad: (1) pneumobilia, (2) aberrantly located radio-opaque gallstone, (3) intestinal dilatation/obstruction. The Rigler triad can be considered pathognomonic. When diagnosis is still doubtful, an abdominal ultrasound (US) can be indicated for gallbladder stones, confirming the presence of choledocholithiasis. The use of US in combination with abdominal films to increase the sensitivity of diagnosis. However, the diagnosis of the ectopic gallstone is...

Conclusion

Gallstone ileus is a rare cause of bowel obstruction with significant mortality. CT imaging allows a prompt diagnosis, to provide early surgical intervention and gallstone ileus resolution.

Personal information

J.P. Zawaideh1, S. Banderali2, L. Bacigalupo2, G.A. Rollandi.2 1 Radiology Unit,Department of Health Sciences, University of Genoa, Genoa, Italy. 2 Radiology Unit, Department of Diagnostic Imaging, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy.

References

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