PMC6159182_01
Non-contrast CT abdomen and pelvis. Air is demonstrated in the biliary tree. This was initially attributed to post sphincterotomy pneumobilia.
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f1
Pneumobilia was also noted due to prominence of the hepatic biliary tree (Figure 1).
The arrow marks the location of the choledochoduodenal fistula. A continuous low density tract can be appreciated between the contracted gallbladder and the adjacent duodenum.
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f2
An addendum was added to the CT report, suggesting that the appearances were indicative of a gallstone ileus from a choledochoduodenal fistula (Figure 2) with a non-calcified gallstone possibly being present at the transition point in the left iliac fossa (Figure 3).
The arrow is marking the transition point in the left iliac fossa and what is likely an obstructing non-calcified gallstone. Gas can be appreciated within the gallstone. Following surgical removal, this gallstone measured 41 x 25 mm.
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f3
An addendum was added to the CT report, suggesting that the appearances were indicative of a gallstone ileus from a choledochoduodenal fistula (Figure 2) with a non-calcified gallstone possibly being present at the transition point in the left iliac fossa (Figure 3).