Atypical cases of gallstone ileus evaluated with multidetector computed tomography.
OBJECTIVE
To describe the multidetector computed tomography (CT) findings in 3 patients with atypical gallstone ileus.


METHODS
We retrospectively evaluated computed radiography and CT images from three cases of surgically proven gallstone ileus. Two radiologists evaluated by consensus all images for the presence of ectopic gallstone, small bowel obstruction, intrahepatic pneumobilia, cholecystic pneumobilia. One author recorded whether diagnosis of gallstone ileus was made prospectively on radiologic reports and correlated findings to pathology.


RESULTS
All cases of gallstone ileus were atypical in that one patient had porcelain gallbladder, one had recurrent pyogenic cholangitis, and one was only 35 years of age. Prospective clinical diagnosis of gallstone ileus was made in only 1 patient at computed radiography and all 3 patients at CT. Retrospectively, small bowel obstruction and cholecystic pneumobilia were identified retrospectively in all 3 patients at both computed radiography and MDCT, and an ectopic gallstone, intrahepatic pneumobilia, and choledochoduodenal fistula was seen in 2, 1, and 0 patients at computed radiography and 3, 2, and 3 patients at CT respectively.


CONCLUSIONS
Multidetector CT is an accurate means to diagnose gallstone ileus, even in patients with atypical features. In particular, multidetector CT is useful for identifying the ectopic gallstone at the transition point between dilated and decompressed bowel.
Reimann
Anja J
AJ
Department of Radiology, University of California at San Francisco, San Francisco, CA 94143-0628, USA.
Yeh
Benjamin M
BM
Breiman
Richard S
RS
Joe
Bonnie N
BN
Qayyum
Aliya
A
Coakley
Fergus V
FV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging; D001658:Biliary Fistula / Q000000981:diagnostic imaging; D002761:Cholangitis / Q000000981:diagnostic imaging; D004378:Duodenal Diseases / Q000000981:diagnostic imaging*; D005260:Female; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging*; D005740:Gases; D006500:Hepatic Duct, Common / Q000000981:diagnostic imaging; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D005740:Gases