Gallstone Ileus in an Adult Male Patient: Computed Tomographic Findings and Case Report

Abstract

Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract, and responsible for less than 1% of cases of intestinal obstruction. This is a case of a 50-year-old male who was referred for computed tomography of the abdomen on account of abdominal pain, abdominal swelling and discomfort, restlessness, vomiting, constipation, easy fatigability, excess sweating and restlessness. The scout image of the computed tomography (CT) demonstrated linear streaks and foci of radiolucency beneath and around the 10th and 11th anterior ribs on the right most likely pneumobilia. Air distended bowel loops were also demonstrated. Serial axial slides demonstrated an impacted calculus measuring about 30mm in widest transverse diameter in the right iliac region most probably the ileocecal valve region extending in to the cecum with associated dilated bowel loops showing multiple air-fluid levels raising a suspicion of mechanical bowel obstruction. The gall bladder measures about 50mm x 30mm in cranio-caudal and mediolateral diameter, with turbid contents and thickened walls of about 4mm most likely from cholecystitis. A diagnosis of mechanical bowel obstruction following an impacted calculus at the ileocecal valve was entertained; Gallstone ileus in a 50-year-old man. The patient had surgical treatment, this comprised of exploratory laparotomy with entero-lithotomy, fistula repair and cholecystectomy. The patient did well post-operatively and was discharged home subsequently and advised on follow-up visits. We present a case of mechanical bowel obstruction following an impacted gall stone at the ileocecal valve in a 50-year-old male patient.