PMC4392375_01
Plain X-ray.. A plain chest and abdomen X-ray, showing air-fluid levels and calcium formations (arrow) at the level of mesogastrium/hypogastrium.
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A plain abdominal X-ray showed air-fluid levels and some calcium concretions with sharp outlines at the level of mesogastrium/hypogastrium (Fig. 1).
3D-CT reconstruction.. A 3D reconstruction of CT scan, showing the gallstones stuck at the level of the anastomosis, and another little stone in the right inguinal fossa, inside the right colon (arrow).
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Fig. 2 depicts a 3D reconstruction of the CT scan, performed to better classify and locate the formations.
Intra-operative findings.. The small bowel loops proximal to the site of gallstone impaction (ileotransverse anastomosis) are grossly distended.Purulent fluid is found and removed at the site of excluded bowel segment (terminal ileum and right colon).The surgeon checks that the gallstone does not pass the ileotransverse anastomosis.After disconnection of the anastomosis of the ileotransverse bypass, the impacted gallstone and other three stones are extracted. Another stone was found the right colon.
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Fig. 2 depicts a 3D reconstruction of the CT scan, performed to better classify and locate the formations. The patient underwent emergency laparotomy (Fig. 3).