Gallstone Ileus

Ernesto P. Molmenti, M.D.

N Engl J Med 1996; 335:942September 26, 1996

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Figure 1 Seven days before admission, nausea and crampy abdominal pain developed in a 65-year-old woman with a history of cholecystitis and cholelithiasis. Two days before admission, the pain became more intense, and she vomited, had no bowel movements, and passed no gas. A posteroanterior radiograph obtained during a barium examination of the small bowel shows an irregular collection of barium in the right upper quadrant (Panel A, arrowheads), representing partial filling of the cystic duct. Both jejunum and ileum are markedly dilated, with dilution of the barium in a pattern consistent with small-bowel obstruction. There is abrupt termination of the barium column at the site of an oval intraluminal filling defect (Panel A, arrow). A view of the end of the barium column shows luminal obstruction by a smooth intraluminal mass (Panel B, arrows) with faint calcification of the peripheral rim. Exploratory laparotomy revealed a foreign body in the terminal ileum that was 4 cm by 4 cm and felt hard (Panel C). A gallstone was extracted through a transverse incision (Panel D). The entire length of the intestine was examined in search of other gallstones, but none were found. The patient recovered uneventfully.

Kim Eagle, M.D.

Ernesto P. Molmenti, M.D.
Washington University School of Medicine, St. Louis, MO 63110

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