Elderly Woman With Vomiting

An 85-year-old woman with Alzheimer's disease presented to our emergency department after 2 days of intermittent vomiting. Her initial vital signs showed blood pressure 80/60 mm Hg, pulse rate 170 beats/min, and tympanic temperature of 36.8°C (98.2°F). Physical examination revealed abdominal distention, hypoactive bowel sounds, and right lower quadrant tenderness. Contrast-enhanced computed tomography (CT) showed gallstone ileus with Rigler's triad,1 including an ectopic stone, mechanical bowel obstruction, and pneumobilia (Figures 1 and 2).

http://ift.tt/2D2eAjd