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Introduction: Biliary ileus is a rare emergency condition that mainly affects the elderly population, with a predominance of females and a mortality rate of 12-27%. It is a mechanical intestinal obstruction caused by the impaction of the biliary calculus within the gastrointestinal tract. It occurs due to the formation of bilio-enteric fistula, as a rare complication of cholelithiasis. Case report: A 73-year-old male patient with epigastric pain, nausea and vomiting was referred for ultrasound exam. The analysis of the clinical-biochemical status of the patient as well as the ultrasound examination of the abdomen itself raised the suspicion of small intestine obstruction, due to the enclaved biliary calculus. After an urgent exploratory laparotomy, the diagnosis was confirmed, and enterotomy was successfully performed with calculus extraction. Cholecysto-duodenal fistula has been confirmed as a major cause of biliary ileus. The post-operative course was uneventful. Conclusion: This case report highlights the enormous importance of ultrasound diagnostics in diagnosing biliary ileus using the criteria of The Rigler Triad, which includes pneumobilia, intestinal obstruction and ectopic calculus. Initially unrecognised cause of obstruction and a late diagnosis correlated with bad prognosis. Ultrasonographic examination of these patients can be a sufficient diagnostic modality in making an accurate diagnosis and further surgical treatment of these patients

Accessory liver lobes (ALL) are defined as supranumerary liver lobes, composed of normal liver parenchyma in continuity with the liver, in contrast to ectopic liver lobes (ELL) that have no anatomical continuity with the normal liver. Case report: In this article we report on a rare radiological diagnosis of an synchronous accessory and ectopic liver lobe using ultrasonography (US) and computed tomography (CT). A 59-year-old female with no symptoms was admitted to our hospital due to preventive exam. Abdominal ultrasonography revealed a high echoic 6 cm x 5 cm soft tissue area in right anterior subhepatic space with distinct margins, a uniform echo and blood flow and was suspected to be abdominal tumor. An enhanced abdominal computed tomography (CT) showed the irregular 65 mm x 48 mm x 32 mm mass in the right hypochondrium below IV and V liver segment with clear margins, a uniform density, texture and contrast enhancement as normal liver tissue. In same patient CT also showed small 16 mm x 12 mm mass in posterior mediastinum in right retrocrural space so diagnosis of accessory and ectopic liver lobe was confirmed. An accessory liver lobe is adjacent and attached to the liver by its own mesentery, while an ectopic liver lobe is one that is completely detached from the normal liver parenchyma. Conclusion: Ultrasound can show mass in the abdomen, which is most commonly in the subhepatic area, but very rarely can initially diagnose ALL or ELL due to different echogenicity of the liver parenchyma in different acoustic windows. In the case of an atypical CT presentation, an MR examination of the abdomen is indicated but it is very rarely. Fast and accurate radiological diagnosis of ALL and ELL is important in the prevention of unnecessary invasive diagnostic procedures such as laparotomy and thoracotomy which are needed only in cases of complications.