Gallstone Ileus on CT Scans

-This CT demonstrates the classic Rigler’s Triad of gallstone ileus: Pneumobilia (air in the biliary tract), low small bowel obstruction with distended small bowel loops, and an impacted gallstone in the terminal ileum.
-Discussion
Gallstone ileus is the name given to the mechanical small bowel obstruction caused by a gallstone impacting in the terminal ileum. The gallstone passes through a cholecystoduodenal fistula, travels the length of the small bowel, and then obstructs just proximal to the ileocecal valve. It is an unusual complication of cholecystolithiasis and chronic cholecystitis.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=c1310251-d7d5-47e3-897d-e64cef4d2f56

MRI T2 image showed hyper-intense bile

with hypo-intense peripheral zone of stone

with central zone of hyper-intensity.

Reference:BiblioMed Textbook-Computed Body Tomography

bile appears hyperintense while calculus

appears with no signal

2 calculi with peripheral calcified rim

black arrow=the first calculus with density

central similar to that of blie while the other one

contain gas in its central.

multiple filling defects seen within bile

due to pure cholesterol calculi.

Reference:BiblioMed Textbook-Computed Body Tomography

facetted gall bladder stone

densely calcified periphery with punctate

central calcification.

Reference:BiblioMed Textbook-Computed Body Tomography

laminated gall bladder calculus

curved arrow=densely calcified peripheral rim

surround a hypodense rim which surround another

faintly calcified rim(straight arrow).This a laminated

gall bladder calculus.

gall bladder(g)filled with contrast following

ERCP showed a filling defect(arrow) had

same attenuation as that of bile(arrow head)

which make it radiolucent in absence of

contrast of ERCP.

Reference:BiblioMed Textbook-Computed Body Tomography

arrow=stones.

Reference:BiblioMed Textbook-Computed Body Tomography