title: Diagnosis of gallstone ileus by serial computed tomography.
abstract: An unusual case of choledocholithiasis followed by gallstone ileus documented by serial computed tomography is reported. A 91-year-old woman underwent gastrostomy because she repeatedly developed aspiration pneumonia, and a common bile duct stone was detected. She and her family refused surgery once symptoms resolved. One year later, she presented with increasing, intermittent abdominal pain and nausea. Abdominal computed tomography revealed a common bile duct stone with inflammatory changes, but the patient still refused surgery. Three months later, she was admitted with abdominal pain and vomiting. On admission, plain abdominal radiographs demonstrated proximal small bowel obstruction. A long ileus tube was inserted through the gastric fistula. Two days after admission, gallstone ileus was diagnosed on abdominal computed tomography based on the presence of pneumobilia, disappearance of the common bile duct stone, fluid-filled bowel loops, and the discovery of an impacted stone in the small bowel. Ten and 15 days after admission, repeated computed tomography demonstrated the impacted stone in the terminal ileum. Seventeen days after admission, a laparotomy was performed, and a 5x3-cm gallstone was removed through an ileotomy.
authors.affiliation: First Department of Surgery, Nippon Medical School, Tokyo, Japan. hiroshiy@nms.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirakata
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kawano
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mizuguchi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Arima
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
authors.forename: Eiichi
authors.initials: E
authors.lastname: Uchida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D042883:Choledocholithiasis / Q000150:complications*; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D045823:Ileus / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D011859:Radiography