31 Gallstone ileus Fig. 31.1A This patient has gallstone ileus. This is a rare cause of small bowel obstruction but should always be sought on plain films as this is how the diagnosis is made. Background In gallstone ileus, the gallbladder adheres to the small bowel and a fistula forms between its lumen and the small bowel lumen. Stones from the gallbladder pass into the small bowel where they become impacted at the terminal ileum. Clinical features Clinical features are those of small bowel obstruction. Radiological features Remember that gallstones are only radio-opaque in 10% of cases but do look for them in the region of the terminal ileum. Not seeing a gallstone in the bowel does not exclude this diagnosis. Fig. 31.1B Pneumobilia should be seen – look for air outlining the branching biliary tree (arrow 1). This air enters the biliary system from the duodenum (the biliary system normally contains no air). Air in the biliary tree occupies a central location within the liver and may resemble the trunk and central branches of a tree – this distinguishes it from portal venous gas where the gaseous lucencies are seen within the periphery of the liver and are generally finer in nature. In gallstone ileus, pneumobilia will coexist with small bowel obstruction (arrow 2) (see Chapter 30). Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related posts: Permanent pacemakers Gastric outlet obstruction Chronic pancreatitis Large bowel obstruction Brodie’s abscess Slipped upper femoral epiphysis Stay updated, free articles. Join our Telegram channel Join Tags: On-Call X-Rays Made Easy Aug 20, 2016 | Posted by admin in ULTRASONOGRAPHY | Comments Off on Gallstone ileus Full access? Get Clinical Tree
31 Gallstone ileus Fig. 31.1A This patient has gallstone ileus. This is a rare cause of small bowel obstruction but should always be sought on plain films as this is how the diagnosis is made. Background In gallstone ileus, the gallbladder adheres to the small bowel and a fistula forms between its lumen and the small bowel lumen. Stones from the gallbladder pass into the small bowel where they become impacted at the terminal ileum. Clinical features Clinical features are those of small bowel obstruction. Radiological features Remember that gallstones are only radio-opaque in 10% of cases but do look for them in the region of the terminal ileum. Not seeing a gallstone in the bowel does not exclude this diagnosis. Fig. 31.1B Pneumobilia should be seen – look for air outlining the branching biliary tree (arrow 1). This air enters the biliary system from the duodenum (the biliary system normally contains no air). Air in the biliary tree occupies a central location within the liver and may resemble the trunk and central branches of a tree – this distinguishes it from portal venous gas where the gaseous lucencies are seen within the periphery of the liver and are generally finer in nature. In gallstone ileus, pneumobilia will coexist with small bowel obstruction (arrow 2) (see Chapter 30). Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related posts: Permanent pacemakers Gastric outlet obstruction Chronic pancreatitis Large bowel obstruction Brodie’s abscess Slipped upper femoral epiphysis Stay updated, free articles. Join our Telegram channel Join Tags: On-Call X-Rays Made Easy Aug 20, 2016 | Posted by admin in ULTRASONOGRAPHY | Comments Off on Gallstone ileus Full access? Get Clinical Tree
