Medical history of gallstones without treatment had acute onset of dull abdominal pain for 2 weeks. He had no fever, nausea, vomiting or diarrhoea.
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A high density gallstone-in-gallstone with a diameter of 1.5 cm and gallbladder distension with wall thickening and peripheral fat stranding, compatible with acute cholecystitis.
The patient had an atypical gallstone-in-gallstone. The special structure might be due to recurrence of gallstones formation at different points in time. The previous gallstone was covered layer-by-layer, resulting in a concentric sphere. The patient was discharged after antibiotic treatment and scheduled for a cholecystectomy a month later.