This post is an answer to the Case – Colicky Pain, Vomiting, and Constipation – What’s the Cause?
What radiological abnormalities are seen ?
- Gas-filled distended stomach.
- Paucity of distal bowel gas.
- Gas within biliary ductal system (aerobilia).
- A laminated, concentrically calcified nodule is present in the left lower quadrant.
- Another densely calcified radio-opacity in the suprapubic region is likely to be a calcified fibroid.
Diagnosis: Gallstone ileus
Gallstone ileus is caused by passage of a large gallstone into the small bowel (by eroding through the bowel wall), and eventually impacting itself within a narrow part of the bowel causing obstruction (partial or complete). Gallstone ileus is a rare cause (<1%) of mechanical small bowel obstruction. A stone needs to be 25 mm or larger to cause such obstruction. The sites of obstruction in descending order of frequency are: Ileocaecal valve or other parts of small bowel >> duodenum >> sigmoid colon.
The presence of bowel dilatation, aerobilia and a radio-opaque gallstone in the abdomen should raise the suspicion of gallstone ileus.
