Gallstone ileus analysis of radiological findings in 27 patients
Introduction
Gallstone ileus is an infrequent cause of intestinal obstruction accounting in the literature for 1–3% of all mechanical intestinal obstruction. It is more frequently observed in elderly women with a female:male ratio of 6:1 and has a high mortality level if not diagnosed early [1], [2], [3], [4]. Symptoms are often insidious at onset, with alternate phases of improvement and relapse corresponding to the progression of the stone along the digestive tract [2], [5], [6]. Plain abdominal radiographs have for long been the fundamental tool to recognise the pathology, the main signs being those described by Rigler et al. [7] who identified the classical triad composed by pneumobilia, detection of the ectopic stone and mechanical ileus and by Balthazar and Schechter [8] who described the sign of air in gallbladder.
Ultrasound [9], [10], [11], [12], [13] and CT scan [14], [15], [16], [17], [18], [19], [20], [21] have been reported to be powerful tools in obtaining early and definitive pre-operative diagnosis.
The purpose of this study is to retrospectively evaluate the diagnostic value of RX, US and CT of the abdomen.
Section snippets
Materials and methods
Between April 1997 and October 2002 we observed 27 patients (4 men, 23 women; age range 58–96 years; mean age 71.5 years) with surgically proven gallstone ileus. We retrospectively analysed RX, US and CT examination performed before the intervention.
Abdominal RX was performed in upright position in 19 cases, on supine patients in eight cases.
Ultrasound examination was performed with a 3.5 MHz convex probe and with a 7.5 MHz linear probe.
Helical CT was performed with the following parameters: 4 mm
Results
RX demonstrated in 24 patients radiological signs of bowel obstruction (88.89%) with evidence of bowel loop distension; in 21 (77.78%) air–fluid levels were also observed; in 10 (37.04%) pneumobilia was described; successive re-evaluation of the plain film and of the scout view of the CT increased the number of observation to 15 (55.56%). In nine patients (33.33%) an ectopic stone was described at first radiological report (Fig. 1), stones were observed in nine cases more using the window
Discussion
In our series, biliary ileus accounted for 2.73% of all intestinal obstruction that required surgery. In 16 patients the stone was located in the ileum (59.26%) (Fig. 1, Fig. 3, Fig. 4), in seven in the jejuneum (25.93%) (Fig. 5); one of the latter patients had two stones in the jejuneum; one patient had a stone located in stomach [22], one in duodenum (Bouveret’s syndrome) [22], [23], [24], [25], [26], [27], [28], [29], [30] (Fig. 9), one in colon [31], [32]. Furthermore, we have observed in
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2022, International Journal of Surgery Case ReportsGallstone ileus associated with cholecystogastric fistula: Case report, diagnosis and surgical treatment
2021, International Journal of Surgery Case ReportsCitation Excerpt :On examination, 3 main findings are sought: aerobilia (due to the presence of air in the gastrointestinal tract through the fistula with the gallbladder), loop distension due to the obstruction, and the ectopic gallstone [13]. There are divergent values regarding the finding of all elements of Rigler's triad in patients, ranging from 11.11% to 77.78% [5,14]. Cholangioresonance can be useful to assess the fistula and biliary tract, however, due to the clinical status of the patient, this exam is not the most appropriate, even more than the fistula, even though it can be seen in other exams, it does not always follow the biliary ileus [15].
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