There is a wide spectrum of diseases affecting the biliary system, many of which present clinically with right hypochondrium pain and jaundice. In relation to the frequency of occurrence, acute cholecystitis is usually the first diagnostic consideration to rule out. However, there are other pathologies that also have as a common factor the presence of biliary concretions, which migrate and impact in different tracts of the intra and extra hepatic biliary tract as well as in the rest of the digestive tract, producing the different pathological entities.
Educational Goals / Teaching Points
In this presentation, we will discuss syndromes and pathologies associated with ectopic gallstone obstruction, among them: Caroli disease, Bouveret's syndrome, biliary ileus, Mirizzi's syndrome, biliary pancreatitis, choledocholithiasis, and bilioenteric fistula.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Ultrasonography is the most sensitive method for the diagnosis of bile duct dilatation, although tomography is currently more useful because it is a noninvasive method with rapid image acquisition; it also has a sensitivity of approximately 80% in the detection of gallstones, depending on their composition; and it helps to plan the surgical approach. Another current and more useful diagnostic modality is MR cholangiopancreatography, since it allows identifying anatomical variants, bile duct dilatation, and complications associated with gallstones.
The different imaging methods have an important role in determining the location of biliary lithiasis, as well as the severity of various pathologies according to their location, being important for both diagnosis and therapeutic planning.