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

Figure 12

Unenhanced computed tomography in the same case of Bouveret’s syndrome than Figure 4(a) shows a large slightly hyperattenuating filling defect (arrow) in the duodenal bulb. A fistula between the gallbladder (black arrowhead) and the duodenum (white arrowhead) is evident in (b) after intravenous contrast media administration. The association of ectopic gallstone visualization, pneumobilia (seen in (c)), and signs of intestinal obstruction (gastric overdistension visible in (c)) constitute Rigler’s triad. In a previous unenhanced computed tomography (d), a smaller hyperattenuating calculus was detectable in the gallbladder: this finding represents a clue to the diagnosis of gallstone ileus.

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