Evaluation and diagnosis of gallstone ileus using point of care ultrasound in the Emergency Department

  • Steven Van Rees Mercy Health Partners, Muskegon, MI, United States.
  • Kristen Price Mercy Health Partners, Muskegon, MI, United States.
  • Joseph Betcher | joebetcher@gmail.com Mercy Health Partners, Muskegon, MI, United States.

Abstract

A 75-year-old female presented to the Emergency Department (ED) with nausea, feculent emesis and abdominal distension. On previous visit the patient was diagnosed with a 2.2x1.9x1.1 cm ectopic gallstone in the mid small bowel without evidence of ileus or bowel obstruction and was subsequently discharged home. She returned 2 days later, abdominal plain radiographs revealed mildly dilated small bowel with air-fluid levels and a calcified mass in the right hemipelvis. Bedside ultrasound was performed and an air filled gallbladder with a fistulous tract was visualized. Dilated loops of bowel were visualized with an abnormal back and forth movement of intestinal contents, consistent with a small bowel obstruction. Patient went on to have an uncomplicated surgical extraction of the gallstone with resolution of her ileus. We would propose using point-of-care ultrasonography with abdominal plain films as an adjunct for evaluation and diagnosis of gallstone ileus in elderly patients.

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Published
2020-04-09
Info
Issue
Section
Images in Emergency
Keywords:
Gallstone ileus, ultrasound, cholecysto-enteric fistula
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How to Cite
Van Rees, S., Price, K., & Betcher, J. (2020). Evaluation and diagnosis of gallstone ileus using point of care ultrasound in the Emergency Department. Emergency Care Journal, 16(1). https://doi.org/10.4081/ecj.2020.8570