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Coronal CT image of abdomen demonstrating a hyperechoic mass in the sigmoid colon.
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A computerized tomography (CT) scan (Fig. 1) showed cholecystitis; a cholecystocolonic fistula between gallbladder and hepatic flexure of colon; widespread diverticulosis and a high attenuation mass (representing a gallstone) in the proximal sigmoid colon.
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Gallstone impacted within the sigmoid colon.
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CT (Fig. 2) demonstrated a large calcified gallstone (maximum diameter 4.8 cm) in the distal sigmoid colon, with mural thickening, oedema, and inflammatory stranding of the mesenteric fat.
Gallstone remains impacted within the sigmoid colon.
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Repeat CT (Fig. 3) one week after the initial presentation still demonstrated sigmoid gallstone ileus with only partial resolution of the bowel dilatation.
Large gallstone following manual evacuation.
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The large stone was manually palpated within the proximal rectum and subsequently removed via manual evacuation (Fig. 4).
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Axial CT image - 3.6 cm gallstone impacted within distal ileum.
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Abdominal X-Ray 5 days post laparotomy.
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Sequential abdominal x-rays (Fig. 6) post laparotomy repeatedly demonstrated dilated loops of large and small bowel.