Presentation
Abdominal pain, nausea, and vomiting.
Patient Data
a cholecystoenteric fistula with intraluminal gas is demonstrated between the gallbladder and the duodenum
presence of an obstructed calculus of diameter 22mm located at the mid ileum with proximal dilatation of small bowel loops and stomach
small volume intraperitoneal free fluid
Case Discussion
These radiologic findings were consistent with small bowel obstruction secondary to gallstone ileus. In this case, the patient had a history of chronic cholecystitis facilitating the formation of a cholecystoenteric fistula and migration of a gallstone into the small bowel. This gallstone subsequently became impacted at the mid ileum causing a small bowel obstruction.
The patient underwent a laparoscopic-assisted enterotomy for the removal of the gallstone with an uncomplicated recovery. The cholecystoenteric fistula was followed up as an outpatient with a repeat scan for consideration of a delayed procedure for fistula repair.
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