So we have dilated bowel loops. We have clips in the RUQ. And there is a subtle square to rounded hyperdensity in the RLQ, in the region of the….. ileocecal valve…

Answer: Gallstone ileus.

Yeah, this is a total misnomer. It’s not an ileus at all but rather a mechanical small bowel obstruction secondary to a passed gallstone (which classically comes from a gallbladder-small bowel fistula due to chronic cholecystitis). Classic obstructing location is terminal ileum/ileocecal valve.

Yes, this study was post-cholecystectomy, but I guess the stone had already passed into the GI tract. This gives you yet another type of stone to look for on abdomen X-rays!