Monday, September 15, 2008


This week is obstruction week! Here's the first case:

A 70 year old woman presents with intermittent abdominal pain and vomiting over the last few days. Past medical history is significant for coronary artery disease, COPD, and diabetes mellitus. There is no history of abdominal surgery. On exam, the patient is febrile, appears dehydrated, has increased bowel sounds, and has abdominal distension. Here's a CT with contrast:

The red and blue arrows note air, the yellow arrow notes the pathological finding, and the green arrow notes dilated and fluid-filled small bowel.

Challenge: This is small bowel obstruction but what specifically is the etiology?

Image shown under fair use.

1 comment:

Craig said...


This is gallstone ileus: impaction of a gallstone in the ileum after passing through a biliary-enteric fistula. It is an unusual complication of cholelithiasis and an uncommon cause of obstruction. Pericholecystic inflammation after cholecystitis leads to adhesions between the biliary and enteric systems. Pressure necrosis by the gallstone then causes erosion and fistula. On the CT, air is noted in the gallbladder and common bile duct (pneumobilia) and the yellow arrow notes the gallstone.

Sources: UpToDate; LearningRadiology.