A 65-year-old male presents with abdominal pain, vomiting, and a history of multiple episodes of cholecystitis. X ray image is given below.What is the most likely diagnosis?
A. Acute cholecystitis B. Gallstone ileus C. Small bowel volvulus D. Duodenal perforation
Answer:B. Gallstone ileus
Explanation: Rigler's Triad consists of pneumobilia, small bowel obstruction, and an ectopic gallstone, which is diagnostic of gallstone ileus. This condition occurs when a gallstone enters the bowel through a biliary-enteric fistula, leading to mechanical obstruction.
A large gallstone (>2.5 cm) erodes through the gallbladder wall, creating a cholecysto-enteric fistula (most commonly into the duodenum).
The stone enters the bowel and may cause obstruction, most often at the ileocecal valve due to its narrow lumen.
The presence of air in the biliary tree (pneumobilia) results from communication between the biliary and intestinal tracts.
a) Mortality more than that of calculus cholecystitis
b) GB rupture chances are more
c) Immediate cholecystectomy is the treatment of choice
d) Only A & B are correct
A12) d
The disease process is generally more fulminant than that of calculous cholecystitis and may progress to gangrene and perforation of the gallbladder.
Treatment of acalculous cholecystitis is similar to that of calculous cholecystitis, with cholecystectomy being therapeutic. Given the substantial inflammation and high risk of gallbladder gangrene, an open procedure is generally preferred.
However, many of these patients are critically ill and would not tolerate the physiologic insult of a laparotomy, explaining why the mortality rate of cholecystectomy for acalculous cholecystitis is up to 40%. Accordingly, percutaneous drainage of the distended and inflamed gallbladder is carried out in patients unable to tolerate a laparotomy.
Approximately 90% of patients will improve with percutaneous drainage, and the tube can eventually be removed. If follow-up imaging continues to demonstrate no stones, interval cholecystectomy is generally unnecessary.