Gallstone ileus from a non-calcified stone: a challenging diagnosis

Abstract

Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case, we discuss a difficult diagnostic case of gallstone ileus with a non-calcified gallstone. An 88-year-old female presented with abdominal pain and vomiting. A CT scan was arranged and showed an evolving bowel obstruction although no frank hyperdensity suggestive of a gallstone was noted. Initially the cause of the bowel obstruction was uncertain, but after discussion with the treating team and further review of the images, the patient was diagnosed with gallstone ileus. The patient underwent emergency surgery and a 41 mm obstructing calculus was removed from the patient’s jejunum, later confirmed on histological diagnosis.

Clinical and radiological diagnosis of gallstone ileus: a mini review

“…Furthermore, the drawback of IV contrast-enhanced CT scanning in gallstone ileus is the difficulty in defining some radiolucent stones or rim-calcified stones [ 43 , 60 ]. Intraluminal radiolucent stones may resemble soft-tissue densities (isoattenuation), e.g., a mass [ 53 , 61 ] or an intussusceptum as reported by Prasad et al [ 46 ]. On the contrary, in contrast-enhanced small bowel, rim-calcified (thus rim-enhancing on CT) stones may go undiagnosed given their strong resemblance to contrast-enhanced small bowel (the radiolucent center of the calculus resembling bowel lumen).…”