GALLSTONE ILEUS

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Abstract
A new roentgenographic sign of gallstone ileus is described. This is called the "loop obturation pattern" and refers to the characteristic appearance of the small bowel occurring in the supine plain roentgenogram of the abdomen. There is minimal to moderate gaseous distention of the small bowel; prominent valvulae conniventes which do not show extreme degrees of effacement; clear delineation of the fluid-containing loops of bowel and frequently a radial configuration of the loops of bowel. The loop obturation pattern occurred in 86 per cent of 35 proven instances of gallstone ileus. In 31 per cent, the loop obturation pattern was present in the absence of gas in the biliary tree on an ectopic calculus. Recognition of the loop obturation pattern is not pathognomonic of gallstone ileus but should alert the radiologist to its presence and provide indication for additional plain roentgenography or contrast medium study for confirmation. The clinical and supine roentgenographic criteria for gallstone obstruction are reviewed.

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