UNCORRECTED PROOF European Journal of Radiology xxx (2003) xxx–xxx 3 Gallstone ileus analysis of radiological findings in 27 patients 4 Francesco Lassandro * , Nicola Gagliardi, Maria Scuderi, Antonio Pinto, Gianluca Gatta, Raffaele Mazzeo 5 6 Department of Radiology, Cardarelli Hospital, Via Stanzione 18, Napoli 80128, Italy 7 Received 12 November 2003; received in revised form 19 November 2003; accepted 27 November 2003 8 Abstract 9 Purpose: We retrospectively compared the clinical value of plain abdominal film, abdominal sonography and abdominal CT in diagnosing gallstone ileus in 27 patients. Material and methods: 27 patients (23 women and 4 men, age range 58–96 years; mean age 71.5 years) with surgically proven gallstone ileus were submitted to plain film, sonography and CT of the abdomen. Abdominal plain films were performed in 19 cases in upright position (postero-anterior projection), in eight cases in supine position. Abdominal US were performed with 3.5 and/or 7.5 MHz probes. CT was performed with a helical unit (slice thickness 4 mm, reconstruction interval 4 mm, pitch 1.5), after intravenous contrast agent (120 ml) infusion (3 ml/s, 55 s acquisition delay from bolus starting) and using a power injector. The following findings were searched on: pneumobilia, air in gallbladder, cholecysto-digestive fistula, extraluminal fluid, bowel loops dilatation, intestinal air–fluid levels, ectopic stones. Results: Plain abdominal films showed the following findings: air–fluid levels (77.78% of cases), bowel loops dilatation (88.89%), site of obstruction (44.4%), pneumobilia (37.04%), air in gallbladder (3.70%), ectopic stone (33.33%). Abdominal sonography demonstrated bowel loops dilatation (44.44%), extraluminal fluid (14.81%), ectopic stones (14.81%), gallbladder abnormalities, (37.04%), pneumobilia (55.56%). CT findings retrospectively observed were: bowel loops dilatation (92.59%), air–fluid levels (37.04%), bilio-digestive fistula (14.81%), pneumobilia (88.89%), ectopic stone (81.48%), extraluminal fluid (22.22%). The Rigler’s triad, that is pneumobilia, bowel mechanical obstruction and ectopic stone detection was observed 4 times with RX (14.81%), 3 times with US (11.11%) and 21 times with CT (77.78%). Conclusions: Air–fluid levels and bowel loop dilatation were the radiological findings more frequently observed in our series. Plain abdominal film allowed us mainly to identify signs of obstruction, US were more effective in disclosing biliary pathology, CT allowed us to correctly diagnose biliary ileus with much higher accuracy. 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 © 2003 Published by Elsevier Ireland Ltd. 26 Keywords: Bowel obstruction; Biliary ileus; Gallstone ileus; Diagnostic imaging 27 1. Introduction 28 Gallstone ileus is an infrequent cause of intestinal obstruc- 29 tion accounting in the literature for 1–3% of all mechanical 30 intestinal obstruction. It is more frequently observed in el- 31 derly women with a female:male ratio of 6:1 and has a high 32 mortality level if not diagnosed early [1–4]. Symptoms are 33 often insidious at onset, with alternate phases of improve- 34 ment and relapse corresponding to the progression of the 35 stone along the digestive tract [2,5,6]. Plain abdominal ra- 36 diographs have for long been the fundamental tool to recog- 37 nise the pathology, the main signs being those described by 38 Rigler et al. [7] who identified the classical triad composed 39 * Corresponding author. Tel.: +39-081578-6114; fax: +39-081578-6114. E-mail address: f.lassandro@tiscalinet.it (F. Lassandro). by pneumobilia, detection of the ectopic stone and mechan- 40 ical ileus and by Balthazar and Schechter [8] who described 41 the sign of air in gallbladder. 42 Ultrasound [9–13] and CT scan [14–21] have been re- 43 ported to be powerful tools in obtaining early and definitive 44 pre-operative diagnosis. 45 The purpose of this study is to retrospectively evaluate 46 the diagnostic value of RX, US and CT of the abdomen. 47 2. Materials and methods 48 Between April 1997 and October 2002 we observed 27 49 patients (4 men, 23 women; age range 58–96 years; mean 50 age 71.5 years) with surgically proven gallstone ileus. We 51 retrospectively analysed RX, US and CT examination per- 52 formed before the intervention. 53 1 0720-048X/$ – see front matter © 2003 Published by Elsevier Ireland Ltd. 2 doi:10.1016/j.ejrad.2003.11.011 EURR 2524 1–7