Rolling in the Deep: Imaging Findings and Diagnostic Pearls in Gallstone Ileus

Figure 10

Contrast-enhanced computed tomography in the same patient than Figure 3 allows the depiction of a cholecystoduodenal fistula (arrow) with a linear air collection entrapped in the fistulous communication. Please note in (a) a small air bubble in the gallbladder lumen not detectable at abdominal radiograph, and rim calcification of the gallbladder wall (porcelain gallbladder; arrowheads). Dilated fluid-filled small bowel loops and decompressed distal small bowel consistent with obstruction are evident in (a) and (b). The point of transition corresponds to an isoattenuation intraluminal filling defect with a thin peripheral calcified rim.

(a)

(b)