[Nine consecutive patients with gallstone ileus. Personal experience].

INTRODUCTION

Gallstone ileus is a mechanical obstruction of the gastrointestinal tract caused by the impaction of one or more gallstones within the bowel lumen. The insidious clinical presentation and the lack of specific signs of biliary disease are responsible for the delayed preoperative diagnosis which leads to an overall mortality rate of 15%.

MATERIAL AND METHODS

A series of 9 consecutive patients (7 women and 2 men, age ranging from 17 to 83 years), with surgically proved gallstone ileus, was retrospectively reviewed: the authors report the radiologic procedures performed preoperatively and the diagnostic findings. Plain abdominal radiographs were performed in 4 of 9 patients, abdominal US in 4 and CT in 7 patients. All radiologic examinations were retrospectively reviewed by all authors independently, to recognize the different signs of gallstone ileus.

RESULTS

The signs of Rigler's triad (small bowel obstruction, ectopic gallstones and air in the biliary tree) were observed on plain abdominal films in two cases, and ectopic gallstones and pneumobilia in two cases. The ectopic gallstones and the small bowel obstruction were demonstrated on abdominal US images in three cases. Rigler's triad was identified on abdominal CT images in 4 cases, while two findings (small bowel obstruction and ectopic gallstones) were observed in three cases.

CONCLUSIONS

When the bowel is obstructed by a radiopaque calcified stone, plain radiographs and US of the abdomen are usually enough to diagnose gallstone ileus and no further studies are required.