EURORAD ESR

Case 13967

A rare variant of gallstone ileus

Author(s)
La Pietra P, Chiaravalloti D, Sommario M, Parpanesi R, Giombi A

Ospedale Bentivoglio, Asl Bologna, Dipartimento servizi; Via Marconi 40121 Bentivoglio, Italy; Email:plapietra@tin.it
 
Patient
male, 79 year(s)
 
 
  • Figure 1
    X-ray
     

    Abdominal radiogram showed a moderate gastric dilatation (asterisk), air in the biliary tract (arrows) and an ectopic large gallstone in the upper right abdominal quadrant mistaken for an orthotopic gallstone (red...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Abdominal radiogram (magnified image of upper right quadrant) showed air in the biliary tract and an ectopic large gallstone mistaken for an orthotopic gallstone.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: Image manipulation / Reconstruction; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Gastografin meal shows gastric dilatation with a complete gastric outlet obstruction and a intraluminal duodenal filling defect by gallstone impacted in duodenum.

     
    Area of Interest: Abdomen; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Gastografin meal after surgery showed a large bilio-duodenal fistula and complete retrieval of the gastric-duodenal transit.

     
    Area of Interest: Abdomen; Imaging Technique: Plain radiographic studies; Procedure: Barium meal; Special Focus: Fistula;
     
     
  • Figure 2
    CT
     

    Non-enhanced CT (axial view) shows a big calcified gallstone, wedged in the duodenum.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Non-enhanced CT (axial view) shows aerobilia in the left hepatic lobe.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Non-enhanced CT (axial view) shows gastric dilatation and the gallblader filled with fluid and air with air-fluid level.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Non-enhanced CT (coronal MPR image) shows gallstone, wedged in the duodenum and the bilio-duodenal fistula with gallblader filled with air.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Computer Applications-3D; Special Focus: Fistula;

    Non-enhanced CT (coronal MPR image magnified) shows a gas-filled fistulous connection between the gallbladder and the duodenum. (red arrow)

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Computer Applications-3D; Special Focus: Fistula;
     
     
  • Figure 3
    Endoscopy

    Endoscopic image showing the large gallstone that is causing gastric outlet obstruction.

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: Image manipulation / Reconstruction; Procedure: Biopsy; Special Focus: Calcifications / Calculi;
     
     
  • Figure 4
    Specimen

    Clinical photography shows the removed ectopic gallstone (4.5x3.5 cm).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: Image manipulation / Reconstruction; Procedure: Biopsy; Special Focus: Calcifications / Calculi;
     
     
Abdominal radiogram showed a moderate gastric dilatation (asterisk), air in the biliary tract (arrows) and an ectopic large gallstone in the upper right abdominal quadrant mistaken for an orthotopic gallstone (red circle).
 
Abdominal radiogram (magnified image of upper right quadrant) showed air in the biliary tract and an ectopic large gallstone mistaken for an orthotopic gallstone.
 
Gastografin meal shows gastric dilatation with a complete gastric outlet obstruction and a intraluminal duodenal filling defect by gallstone impacted in duodenum.
 
Gastografin meal after surgery showed a large bilio-duodenal fistula and complete retrieval of the gastric-duodenal transit.
 
Non-enhanced CT (axial view) shows a big calcified gallstone, wedged in the duodenum.
 
Non-enhanced CT (axial view) shows aerobilia in the left hepatic lobe.
 
Non-enhanced CT (axial view) shows gastric dilatation and the gallblader filled with fluid and air with air-fluid level.
 
Non-enhanced CT (coronal MPR image) shows gallstone, wedged in the duodenum and the bilio-duodenal fistula with gallblader filled with air.
 
Non-enhanced CT (coronal MPR image magnified) shows a gas-filled fistulous connection between the gallbladder and the duodenum. (red arrow)
 
Endoscopic image showing the large gallstone that is causing gastric outlet obstruction.
 
Clinical photography shows the removed ectopic gallstone (4.5x3.5 cm).
 
 
 
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