PMC7649418_01
Computed Tomography Abdomen Axial and Coronal. A) 5.8 cm (red line) laminated and partially calcified stone is noted in the first and second portions of the duodenum with B) pneumobilia suggesting cholecysto-duodenal fistula (yellow arrow) and associated signs of gastric outlet obstruction.
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CT scan demonstrated pneumobilia, massive gastric distension, and an obstructing 5.8 cm calcified intraluminal mass in the first and second portion of the duodenum (Fig. 1).
Intraoperative View and Gross Specimen - Exposure of impacted obstructing calculus (white arrow) in situ after fistula takedown. Pylorus (dashed line) incised to allow for stone extraction. Fogarty catheter placed through cystic (circle) duct stump into duodenum to enable identification of CBD and location of Ampula of Vater.
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This required extension of the defect over the anterolateral surface of D1 through the pylorus and a 6.2 x 4.2 x 3.5 cm stone was successfully removed (Fig. 2, Fig. 3).