Biliary colon: an unusual case of intestinal obstruction

A female, 80-year-old, diabetic, hypertensive and obese patient reported sudden onset of colicky pain in the hypogastrium for two days. Also, there was association with nausea, and the patient was unable to eliminate feces and pass gas, besides presenting with abdominal distension. Physical examination demonstrated increased abdominal volume, pain to deep palpation of the hypogastrium, abdominal tympanism to percussion and signs of mild dehydration. The clinical hypothesis of obstructive syndrome was raised. Abdominal radiographic and sonographic images acquired in other service were not conclusive as regards the cause of the condition. Anteroposterior radiography in orthostasis and horizontal dorsal decubitus position demonstrated the presence of obstruction with predominantly gaseous distension of small bowel loops and part of the large bowel, with no signs of pneumoperitoneum. Ultrasonography demonstrated gaseous distension with no signs of free fluid at the moment of the study. With such studies indicating low obstruction with no defined cause, one has opted for performing abdominal computed tomography (CT) in order to clarify the diagnosis and define the therapeutic approach. Due to the clinical suspicion of neoplastic obstruction, the patient was referred to the authors' institution. With the CT study, the diagnosis could be established, and the several image reconstruction techniques – multiplanar, curve and 3D reconstruction – were utilized so as the findings could be presented to the requesting physician in a more easily understandable way. CT demonstrated the fistulous tract communicating the gall-bladder lumen with the lumen of the transverse colon and the presence of a residual calculus in the gallbladder (Figure 1A). Curve reconstruction of the rectal and sigmoid colon region demonstrated an impacted calculus obstructing the sigmoid colon and Biliary colon: an unusual case of intestinal obstruction Cólon biliar: um caso incomum de obstrução intestinal 3. Salvadori PS, Costa DMC, Romano RFT, et al. What is the real role of the equilibrium phase in abdominal computed tomography? Radiol Bras. When the noncontrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases. et al. Multidetector-row computed tomography in the preoperative diagnosis of intestinal complications caused by clinically unsuspected ingested dietary foreign bodies: a case series emphasizing the use of volume rendering techniques. Figure 1. A: Axial CT image demonstrating the presence of a calculus in the gallbladder (arrow) and fistulous tract communicating the gallbladder with the large bowel (asterisk). B: Curve reconstruction of CT image demonstrating impacted biliary calculus in the sigmoid …