More than meets the eye: subtle but important CT findings in Bouveret's syndrome.
OBJECTIVE
Gallstones are a rare cause of duodenal or gastric outlet obstruction and therefore are not commonly suspected. Rigler's radiographic triad of pneumobilia, bowel obstruction, and an ectopic gallstone is seen in few of these patients. The symptoms are insidious and nonspecific, and the diagnosis is usually made radiologically. Although CT scans are far more sensitive, 25% of cases are still missed, often because the size of the offending gallstone is underestimated.


CONCLUSIONS
Better assessment of stone size, and therefore higher accuracy of diagnosis, could be achieved if attention is paid to more subtle but nonetheless important signs. These include compressed air in dependent areas of the duodenal lumen, an area of soft-tissue rather than fluid density surrounding the calcified rim of the stone, and a faint radiolucency in or beyond this soft-tissue area that could represent laminations of fat or air in the stone.
Department of Upper Gastrointestinal Surgery, Heartlands Education Center, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
Susan
S
Gan
Shuvro
S
Roy-Choudhury
Sanjay
S
Agrawal
Harish
H
Kumar
Arvind
A
Pallan
Paul
P
Super
Martin
M
Richardson
D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography / Q000379:methods*; D004380:Duodenal Obstruction / Q000000981:diagnostic imaging*; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging*; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D013577:Syndrome; D014057:Tomography, X-Ray Computed / Q000379:methods*