Reasoned diagnostic approach to a case of small bowel obstruction
Stamati, G.; Ierardi, A.M.; Minordi, L.M.; Cina, A.; Meduri, A.; Vecchioli, A.
Rays 30(1): 71-76
2005
ISSN/ISBN: 0390-7740 PMID: 16022124 Document Number: 589088
The case of a 73-year-old male patient come to the Emergency Department for epigastric pain, vomiting and blocked bowel movement is presented. Plain abdominal X-ray performed on emergency showed marked small bowel distention, and air-fluid levels suggestive of intestinal obstruction. CT was indicated to establish its precise site and cause. The presence of a gallstone was evidenced: gallstone ileus was diagnosed. Interestingly enough, at surgery the gallstone was not found; most likely it was expelled spontaneuously during the time elapsed between CT and surgery. Based on imaging findings and a review of the literature it was concluded that the study patient had a rare association of intestinal volvulus and gallstone ileus.