PMC3707284_01
A plain abdominal X-ray suspecting the presence of air in the gallbladder (arrow).
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fig1
The abdominal X-ray was suspicious for presence of air in the gallbladder (Figure 1).
Small arrow showing the presence of air in an intrahepatic bile duct. Large arrow showing gastric dilatation.
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fig2
The stomach was found with mild dilatation (Figures 2, 3, 4, and 5).
Contrast and air inside the gallbladder (arrow).
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fig3
The stomach was found with mild dilatation (Figures 2, 3, 4, and 5).
Dilatation of the duodenum (arrow).
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fig4
The stomach was found with mild dilatation (Figures 2, 3, 4, and 5).
A gallstone in the 2nd to 3rd part of the duodenum (arrow).
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fig5
The stomach was found with mild dilatation (Figures 2, 3, 4, and 5).
Five minutes after intake of the oral contrast all the anatomic elements are well visualised: (a) the gallbladder filled with contrast, (b) the cystic duct filled with contrast, (c) the cholecystoduodenal fistula, (d) a duodenal diverticulum of the 3rd part filled with contrast, and (e) a large gallstone impacted on the 2nd to 3rd part of the duodenum.
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fig6
The gallbladder, the cystic duct and the cholecystoduodenal fistula as well as a duodenal diverticulum of the 3rd part were well visualised (Figures 6 and 7).
Fifteen minutes after intake of the oral contrast (a) the evacuation of the gallbladder is well seen as well as (b) the dilatation of the filled up with contrast duodenum proximally to the impacted gallstone and (c) the slight passage of the gastrografin distally to the gallstone in the 4rth part and jejunum.
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fig7
The gallbladder, the cystic duct and the cholecystoduodenal fistula as well as a duodenal diverticulum of the 3rd part were well visualised (Figures 6 and 7).
A cholecystoduodenal fistula orifice noticed in the superior duodenal wall (arrow).
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fig8
The fistula orifice was seen (Figure 8) as well as the proximal side of the gallstone (Figure 9). 
The proximal side of a large gallstone impacted in the 2nd to 3rd part of the duodenum (arrow).
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fig9
The fistula orifice was seen (Figure 8) as well as the proximal side of the gallstone (Figure 9). 
The gallstone located in the first part of the jejunum after successful milking right before jejunotomy (arrow).
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fig11
With gentle milking movements distal removal was achieved in the first part of the jejunum right after the ligament of Treitz (Figure 11).
The extraction of the gallstone right after the ligament of Treitz (arrows).
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fig12
A jejunotomy and successful removal of the gallstone were performed (Figure 12).