0:01

So this next patient is a 75-year-old female with

0:04

jaundice, abdominal pain. Got a CT scan showing the

0:08

bowel a obstruction, and they wanted to get an MRI study

0:11

to, uh, to further evaluate, uh, some of the,

0:14

uh, findings that were seen on the CT scan.

0:19

And so if we scroll through some of these images

0:21

over here, one of the things that we can see,

0:24

I think immediately, is that there are numerous

0:26

distended loops of small bowel in this instance.

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And the other thing we can notice if we

0:30

start to scroll through these images and,

0:32

and look for areas of abnormality is that

0:34

the right upper quadrant looks very abnormal.

0:36

And that's where the gallbladder is located.

0:38

You can actually see the gallbladder over here and,

0:41

uh, it looks very, very thick-walled and inflamed.

0:45

Um, there are some gallstones within it as well.

0:48

And so that just looks like

0:49

an angry-looking gallbladder.

0:50

There are probably a few filling defects within the

0:51

common bile duct as well, and that may account

0:54

for some of the jaundice the patient is having.

0:57

One of the other interesting things that you can

0:58

see on these images, uh, is right over here, right?

1:02

You see a filling defect inside the small bowel.

1:05

It's hypo-intense, and it really looks

1:09

almost identical to some of the filling

1:10

defects seen inside the gallbladder.

1:12

Okay.

1:13

And if you look at all these sequences,

1:16

this is sort of a persistent finding.

1:18

I'll show it to you on the coronal image over here.

1:20

We can see that, uh, the finding is still there.

1:23

It may have moved from sort of its spot over

1:25

here to a little bit more, you know, forward a

1:27

little bit more, but nevertheless, that is the same

1:30

sort of appearance, and it has that sort of

1:32

geographic borders that we see with, uh, with

1:35

gallstones, sort of straight borders here, straight

1:37

borders here, some rounded borders over here.

1:40

And so again, this is another example of a gallstone

1:44

ileus, where a gallstone has sort of passed through

1:46

a fistula from the gallbladder into the small

1:49

bowel and is now lodged inside the small bowel.

1:52

In this instance, it doesn't look like this

1:54

gallstone is causing the bowel obstruction

1:56

because the bowel is in the small bowel.

1:58

distal to this, and it's distended.

2:00

But nevertheless, it's a nice example

2:01

of what that would look like on MR.

2:03

And if we focus on the right upper quadrant, we

2:06

can see that the gallbladder, uh, is very, you

2:09

know, decompressed because it's inflamed, very

2:11

thick-walled, but there is a fistulous tract.

2:14

And inside the fistulous tract, there

2:15

are a few stones that are extending

2:17

from the gallbladder to the duodenum.

2:19

And this was probably the site where a lot of

2:22

these stones are escaping and lodging inside

2:27

the small bowel.

2:28

And so this was, uh, again, uh, just

2:30

another example of a gallstone ileus.

2:33

Uh, however, uh, this gallstone

2:35

was picked up on the MRI over here.