PMC4975710_01
CT examination showing a cholocystoduodenal fistula with air and gastrografin inside the gall bladder.
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Further CT examination revealed the presence of a cholecystoduodenal fistula with gas in the gall bladder, distended small bowel segments and a rim-calcified gallstone >=2.5 cm inside the small bowel lumen (Fig. 1, Fig. 2).
Bowel rupture site.
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During handling of the bowel, we noticed enteric content inside the abdominal cavity, and further examination revealed a rupture in the antimesenteric part of the small bowel wall, approximately 60 cm from the ileocaecal valve (Fig. 3).
The location of the gallstone inside the bowel lumen and near the terminal ileum. Next to it the ruptured bowel segment.
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Further on, a 3.2 cm egg-shaped gallstone was located in the terminal ileum near the ileocaecal valve, which was advanced upwards, and removed through the ruptured bowel (Figs. 4, 5a,b and 6 ).
(a,b) Removal of the gallstone through the ruptured site.
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Further on, a 3.2 cm egg-shaped gallstone was located in the terminal ileum near the ileocaecal valve, which was advanced upwards, and removed through the ruptured bowel (Figs. 4, 5a,b and 6 ).
A 3.2 cm gallstone found to be the cause of the obstruction.
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Further on, a 3.2 cm egg-shaped gallstone was located in the terminal ileum near the ileocaecal valve, which was advanced upwards, and removed through the ruptured bowel (Figs. 4, 5a,b and 6 ).
Suturing of the ruptured bowel.
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The ruptured bowel wall had adequate blood perfusion, so a debridement and suturing was performed, with no resection (Fig. 7).