PMC4529635_01
(A) Coronal CT image obtained at initial presentation showing acute cholecystitis (filled arrow) and an ischaemic segment of small bowel (filled arrow). (B) Coronal CT image obtained on the tenth post-operative day demonstrating pneumobilia (filled arrow) and small bowel obstruction secondary to a second gallstone (filled arrow). (C) Historical axial CT image demonstrating two 2 cm faceted gallstones within the gallbladder.
gr1.jpg
PMC4529635_01_gr1.jpg
fig0005
No pneumobilia was seen (Fig. 1A). Large volume nasogastric aspirates prompted investigation with a repeat CT scan which demonstrated pneumobilia and small bowel obstruction due to a second gallstone (Fig. 1B). On review of historical imaging, a CT scan 3 years prior to admission revealed 2 large gallstones in the gallbladder, both of which were 2 cm in diameter (Fig. 1C).
Operative specimen of resected segment of ischaemic distal jejunum with patchy necrosis and a retrieved faceted gallstone.
gr2.jpg
PMC4529635_01_gr2.jpg
fig0010
He was taken for laparotomy where a 25 cm segment of ischaemic distal jejunum was resected and found to contain a 2 cm faceted gallstone (Fig. 2).