PMC9150213_01
Multiple cuts of the CT scan showing gastric outlet obstruction caused by a large gallstone in the duodenum (red circle) with associated pneumobilia (yellow arrow).
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F1
CT of the abdomen and pelvis with oral and intravenous contrast showed a large gallstone causing partial gastric outlet obstruction and pneumobilia (figure 1).
Obstructing gallstone identified in D1 during endoscopy.
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F2
These findings, in tandem with Rigler's triad of gastric outlet obstruction, a gallstone in the duodenum and pneumobilia confirmed the diagnosis of a cholecystoduodenal fistula (figure 2).
PMC9150213_02
Gross images of the 5.5 cm gallstone extracted intraoperatively from the duodenum.
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F3
The large 5.5 cm stone was extracted carefully to avoid future distal obstructions from fragmentation (figure 3).