[Computed tomographic diagnosis of biliary ileus]

Rare in the general population, gallstone ileus accounts for 25 per cent of nonstrangulated small bowel obstructions in patients over the age of 65. While mortality has declined over the years, it remains high at 12-17 per cent. This is largely due to the insidious symptoms making the diagnosis difficult and to the aged patient population, with frequent comorbid medical conditions contributing to mortality. Much better than plain radiograph and probably easier than ultrasound, CT makes the correct diagnosis of the classical triad of Rigler: distended small bowel loops, pneumobilia and an ectopic calcified gallstone. We report two cases promptly and specifically diagnosed with CT. The second case was a very rare Bouveret's Syndrome, a gastric outlet obstruction caused by a gallstone. Patients were treated by a one time associated enterolithotomy and cholecystectomy. We recommend the early use of abdominal CT scanning for the investigation of clinical bowel obstruction in the elderly, where gallstone ileus is a more common condition.