Abdominal Pain, Nausea, Vomiting

Abdominal exam demonstrated distension with increased bowel sounds, however, no rebound tenderness or Murphy’s sign.

Figure 1. Dilated loops of small bowel and multiple air fluid levels are seen on the supine and upright abdominal radiograph.

Figure 2. Dilated loops of small bowel and multiple air fluid levels are seen on the supine and upright abdominal radiograph.

Figure 3. Axial CT scan shows a large laminated stone (arrows) in the distal jejunum.

Figure 4. Coronal CT scan image shows a large laminated stone (arrows) in the distal jejunum.

Figure 5. Plain radiograph obtained one year earlier shows a large stone in the gallbladder in the right upper abdomen (arrows).

These findings are consistent with gallstone ileus.

Gallstone ileus refers to intestinal obstruction secondary to gallstone impaction in the GI tract causing mechanical small bowel obstruction.

Gallstones large enough to cause bowel obstruction and typically measure 2.0 cm – 2.5 cm in diameter, leading to impaction in the terminal ileum and ileocecal valve, due to their decreased caliber and less peristalsis activity.

The symptoms associated with gallstone ileus may be acute, chronic, or intermittent and often vary based on the location in the GI tract where impaction occurs.

Treatment of gallstone ileus most commonly involves surgery, consisting of enterolithotomy, cholecystectomy, and repair of fistula, if present.