Tx and Followup:
This case is very interesting because there is imaging before and after the gallstone ileus (GI). The two pre GI images show 3 gallstones. The GI case images show two gallstones in separate bowel loops and one still in the gallbladder. Shortly after the CT, the patient underwent enterotomy; 2 large faceted gallstones were
removed. His gallbladder was not excised because of scarring, as the post GI CT images demonstrate. He was placed on the cholelitholytic agent ursodiol (Actigall) and the stone left in his gallbladder disolved.
He continues to do well... and he is scheduled for a followup upper GI series soon!
This is a "classic" case of gallstone ileus. The gallstones, mineralized in this case, eroded through the gallbladder and into the adjacent small bowel causing a choloenteric fistulae. The hard gallstones travel through the small bowel until they obstruct - often near the terminal ileum.