Use of imaging methods in gallstone ileus

Gallstone ileus is a rare complication of cholecystolithiasis with a high mortality and a high rate of postoperative complications caused by the advanced age of the patients and the often delayed diagnosis. The article shows that the consistent use of conventional radiological methods helps to reduce the high incidence of undetected gallstone ileus. A plain film of the abdomen is mandatory because it yields important information on the presence of an ileus and allows to diagnose gallstone ileus if air in the biliary tree and an aberrantly located gallstone is visible. Signs of an ileus are a frequent finding on abdominal scout films (9 of 9 cases) while the additional signs are often absent (5 of 9 cases). Contrast X-ray studies of the intestine, especially the upper gastrointestinal series with water-soluble contrast media, are of importance because they can help in detecting biliary enteric fistulas or gallstones located in the intestine. Hence, the consistent use of this roentgenologic routine method can promote the accuracy of correct preoperative diagnosis (4 of 7 cases). (orig.)