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October 1973

Barium Enema in Diagnosis of Gallstone Ileus

Arch Surg. 1973;107(4):625. doi:10.1001/archsurg.1973.01350220101022

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To the Editor.—We are writing to describe a case in which gallstone obstruction of the distal part of the ileum was diagnosed preoperatively by barium contrast examination of the colon.

Report of a Case  A 75-year-old white man had a four-day history of intermittent symptoms suggestive of the "tumbling" or "migrating" phenomenon of intermittent obstruction occurring at more caudal areas in the small intestine, as a result of a stone being pushed distally by peristaltic action. The admission roentgenographic diagnosis was small intestinal obstruction. Barium enema examination was performed (Figure), and the barium column refluxed past the ileocecal valve into the terminal part of the ileum, and around an obstructing intraluminal mass (gallstone). Although the intraluminal mass may have represented a tumor, the clinical course suggested a gallstone. At surgery, an obstructing, 3 × 2.3 × 2.0-cm, intraluminal stone was identified and removed.

Comment  There is frequent difficulty in

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