Open AccessEvaluation and diagnosis of gallstone ileus using point of care ultrasound in the Emergency Department
Author(s) -
Steven Van Rees,
Kristen Price,
Joe Betcher
Publication year - 2020
Publication title -
emergency care journal
Language(s) - English
Resource type - Journals
eISSN - 2282-2054
pISSN - 1826-9826
DOI - 10.4081/ecj.2020.8570
Subject(s) - medicine , emergency department , gallstone ileus , ileus , bowel obstruction , abdominal distension , nausea , distension , gallstones , radiology , abdominal ultrasonography , ultrasound , surgery , abdominal pain , projectional radiography , general surgery , radiography , ultrasonography , fistula , psychiatry
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.