Abdominal pain with nausea and vomiting.
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Obstruction of proximal ileum secondary to impaction of a gallstone with distension of the upstream loops.
There is gallbladder fistula with the duodenum and in the gallbladder gas is present.
There is also modest peritoneal effusion.
The fistula is a consequence of a chronic inflammatory process of the gallbladder mucosa secondary to mechanical - ischemating action by decubitus and erosive by friction - of a voluminous calculus or a macro-aggregate of calculations. More rare is neoplastic etiology and the fistulization in gallbladder of a duodenum peptic ulcer is very rare.
Case courtesy Dr.ssa Elena Zanni