[Computed tomographic diagnosis of biliary ileus]

Area of Science:

• Gastroenterology
• Abdominal Imaging
• Geriatric Medicine

Background:

• Gallstone ileus is a rare but serious cause of small bowel obstruction, particularly in elderly patients over 65, accounting for 25% of nonstrangulated cases.
• Despite declining mortality rates, gallstone ileus still carries a high mortality (12-17%) due to diagnostic challenges and patient comorbidities.

Observation:

• The diagnosis of gallstone ileus is often delayed by insidious symptoms, making it difficult in the elderly population with multiple medical conditions.
• Computed tomography (CT) is highly effective in diagnosing the classic triad of gallstone ileus: distended small bowel loops, pneumobilia, and an ectopic calcified gallstone.
• Two cases are presented, including a rare instance of Bouveret's Syndrome (gastric outlet obstruction by a gallstone), both diagnosed promptly with CT.

Findings:

• CT scanning offers superior diagnostic accuracy compared to plain radiography and ultrasound for identifying gallstone ileus.
• Early CT diagnosis facilitated timely surgical intervention, including enterolithotomy and cholecystectomy, for the presented cases.
• The study highlights the successful management of gallstone ileus and Bouveret's Syndrome through prompt CT diagnosis and surgical treatment.

Implications:

• Early abdominal CT scanning is recommended for investigating bowel obstruction in the elderly to improve diagnostic speed and patient outcomes.
• Recognizing gallstone ileus as a significant cause of obstruction in older adults is crucial for timely and effective management.
• CT's role in diagnosing rare presentations like Bouveret's Syndrome underscores its value in complex gastrointestinal cases.