Radiolucent gallstone ileus causing proximal small bowel obstruction: A case report.

Area of Science:

• Gastroenterology
• Abdominal Surgery
• Radiology

Background:

• Gallstone ileus is a rare complication of gallstones eroding into the small bowel, causing obstruction.
• Obstruction typically occurs in the terminal ileum due to its narrow lumen, but other locations are possible.

Observation:

• A 74-year-old woman presented with severe right upper quadrant pain, fever, leukocytosis, and vomiting.
• Imaging revealed proximal small bowel obstruction caused by a radiolucent gallstone, a less common presentation.
• Pneumobilia was present, indicating gallstone ileus even with non-visible stones on computed tomography (CT).

Findings:

• Radiolucent gallstone ileus is a rare but serious condition.
• Computed tomography (CT) detection of gallstones varies based on their composition.
• Large stones can obstruct the proximal small bowel.

Implications:

• Prompt surgical intervention is crucial for managing gallstone ileus.
• Pneumobilia is a key indicator of gallstone ileus, even if stones are not radiopaque.
• Understanding imaging limitations is vital for diagnosing gallstone ileus, particularly with radiolucent stones.