Value of CT in the diagnosis and management of gallstone ileus

Table 1 Causes of SBO in 165 patients.

Cause of SBO	Number of patients
Gallstone ileus	14
Phytobezoar	7
Intussusception	13
Inguinal hernia	10
Spigelian hernia	7
Obturator hernia	3
Transmesosigmoid hernia	1
Appendicitis	6
Perforated appendicitis	4
Periappendiceal abscess	2 (21)
Diverticulitis with rupture	2
Ischemic bowel disease	5
Eosinophilic enteritis	1
Intramural hematoma	3 (22)
Adhesive band	57 (192)
Malignant lymphoma	3
Adenocarcinoma of jejunum	1
Adenocarcinoma of ileum	1
Adenocarcinoma of ileo-cecal valve	9
Adenocarcinoma of ascending colon	17
Adenocarcinoma of hepatic flexure colon	2

Numbers in parenthesis refer to numbers of cases whose final diagnosis was determined either by

¹US-Guide aspiration drainage or

²clinical follow up.

Table 2 Plain film, CT findings and clinical data in 14 cases of gallstone ileus.

Case	1	2	3	4	5	6	7	8	9	10	11	12	13	14
Plain film
Pneumobilia	-	-	+	-	+	-	+	-	+	+	-	-	-
- Gas in gall bladder fossa	-	-	-	-	-	+	-	-	-	-	-	-	-	+
Small bowel obstruction	-	-	+	+	+	+	+	+	+	+	+	+	-	-
Ectopic gallstone	+	-	-	+	+	+	+	-	-	+	-	-	-	-
CT
Pneumobilia	-	-	+	+	+	-	+	-	+	+	-	-	+	-
Gall bladder content	Air	Fluid	Air	Air	Air-fluid	Air	Air-fluid	Air	Air	Air	Air	Air	Fluid	Air-fluid
Small bowel obstruction	+	+	+	+	+	+	+	+	+	+	+	+	+	+
Ectopic gallstone	TC	RC	RC	TC	TC	RC	TC	RC	RC	TC	RC	RC	RC	RC
Other CT findings
Cholecysto-duodenal fistula	-	-	-	+	-	+	-	-	-	+	-	-	-	-
Thickened duodenum (>1cm)	+	+	+	-	-	-	-	-	-	-	-	-	-	-
Ascites	+	+	+	+	+	+	-	+	-	+	-	-	-	-
Thickened small intestine (>1cm)	-	+	-	-	-	+	-	-	-	-	-	-	-	-
Clinical data
Symptom onset duration (d)	1	1	1	2	3	3	3	4	5	5	5	5	5	5
WBC(×109/L) upon admission	24.70	24.50	21.70	16.50	13.90	13.50	12.40	10.25	10.90	5.30	7.30	6.60	9.50	8.30

+: Presence, -: absence TC: total-calcified, RC: rim-calcified.