Question

A 60 yr old obese female presents with abdominal pain, distension, there are increased bowel sounds. There are multiple air fluid levels & there was air in biliary tree. Also there was a H/o hysterectomy 2 years back. Probable diagnosis is

• A. Gall stone Ileus
• B. Small bowel obstruction
• C. Large bowel obstruction
• D. Paralytic ileus

Answer 1

The Correct Option is A

The provided case involves a 60-year-old obese female who presents with symptoms that include abdominal pain, distension, and increased bowel sounds. The presence of multiple air fluid levels and air in the biliary tree, along with a history of hysterectomy 2 years prior, helps narrow down the differential diagnosis. 

To analyze the symptoms and imaging findings:

1. Increased Bowel Sounds: Suggests bowel obstruction, as the intestines attempt to move contents through a blocked section.
2. Multiple Air Fluid Levels: Typically indicate bowel obstruction, as fluid and air accumulate above the site of blockage.
3. Air in the Biliary Tree (pneumobilia): Most commonly associated with a fistula between the biliary system and the gastrointestinal tract.

 

The options provided are:

• Gall stone Ileus
• Small bowel obstruction
• Large bowel obstruction
• Paralytic ileus

 

Given the combination of symptoms and radiological findings, the presence of pneumobilia and air-fluid levels is particularly telling. Gallstone ileus is a condition where a gallstone enters the intestinal tract through a biliary-enteric fistula, usually leading to small bowel obstruction. This scenario aligns closely with the patient's presentation. Therefore, the most probable diagnosis is Gallstone Ileus.