Case of the Week: Gallstone Ileus (X-ray & CT)

In this radiology lecture, we discuss the appearance of gallstone ileus on x-ray and CT.

Key points include:
1) Gallstone ileus is a rare complication of chronic cholecystitis.
2) Actually not an ileus, but a small bowel obstruction.
3) Gallstone migrates through a fistula between gallbladder and small bowel (usually duodenum) and becomes impacted in the terminal ileum.
4) Stone can also impact in the proximal ileum, jejunum, even in the duodenum/distal stomach causing gastric outlet obstruction (Bouveret syndrome).
5) Rigler triad on abdominal x-ray: Small bowel obstruction, pneumobilia and gallstone in the right iliac fossa.
6) Usually affects the elderly and treated surgically.

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