A 67-year-old female patient came to the emergency department complaining of periumbilical abdominal pain, vomiting and absence of fecal incontinence of 6 days duration.
She had severe cutaneous-mucosal swelling and leukocytes of 12,100/mm3.
Abdominal radiography showed dilation of small bowel loops with air-fluid levels and pneumoperitoneum.
A CT scan of the abdomen confirmed the findings, and showed an aerobilia, an impacted calculus in the abdomen and a cavernous fistula.
An urgent laparotomy was performed which revealed an intraluminal calculus of 3 cm in diameter located 100 cm from the Treitz angle and a punctiform perforation at the mesenteric border 40 cm from the Treitz angle.
Enterotomy, extraction of calculi and resection of the perforated intestine were performed.
The patient was seated without complications.
The histological study of the specimen showed an intestinal perforation with necrotic material and food debris inside, as well as two diverticula near the perforation.
