29 yo female with no significant PMH presented with abdominal pain and vomiting. The patient was afebrile, hemodynamically able and had epigastric tenderness on exam. Bedside ultrasound of the epigastric region was obtained. What is the diagnosis?

This ultrasound shows a gallstone in the small bowel with multiple dilated loops of bowel consistent with obstruction. Although on first glance it may appear to be a stone in the gallbladder neck, if you follow the clip through you can see that the fluid-filled structure containing the stone is contiguous with the other fluid-filled, dilated loops of bowel. The gallbladder is not visualized in this clip. CT scan confirmed a small bowel obstruction secondary to an impacted gallstone in the ileum. The patient went the OR for an ex-lap and stone extraction.

Special thanks to Marc Leshner for his superb sonographic skills!

-Allison Zanaboni, MD, Emergency Medicine Ultrasound Fellow