PMC4276087_01
An abdominal film shows dilated small bowel and pneumobila (black arrow).
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An abdominal film soon after admission showed dilation of the small bowel along with air in the biliary tree [Fig. 1].
Coronal, sagittal, and transverse CT imaging shows a 3.5 cm gallstone (white arrows) in the sigmoid colon.
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Subsequent CT scan on that day showed pneumobilia, bowel dilation, and a 3.5 cm gallstone in the sigmoid without any distension of the proximal colon [Fig. 2].
A water-soluble enema demonstrates the gallstone (black arrow) at the level of the sigmoid colon.
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CT finding [Fig. 3]. Colonoscopy was subsequently attempted, but unsuccessful in incorporating the stone.
3.7 cm x 3.0 cm x 2.7 cm barrel-shaped gallstone.
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The pathology report described a 3.7 cm x 3.0 cm x 2.7 cm barrel-shaped gallstone [Fig. 4].
Area of stricture in the sigmoid colon around the level of the perforation with a luminal circumference narrowed to 3.5 cm.
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Of note, there was an area of stricture around the level of the perforation located 8.5 cm from the distal margin with a luminal circumference narrowed to 3.5 cm [Fig. 5].