case_images: PMC9150213_01
case_images: Multiple cuts of the CT scan showing gastric outlet obstruction caused by a large gallstone in the duodenum (red circle) with associated pneumobilia (yellow arrow).
case_images: tsaco-2022-000945f01.jpg
case_images: PMC9150213_01_tsaco-2022-000945f01.jpg
case_images: F1
case_images: CT of the abdomen and pelvis with oral and intravenous contrast showed a large gallstone causing partial gastric outlet obstruction and pneumobilia (figure 1).
case_images: Obstructing gallstone identified in D1 during endoscopy.
case_images: tsaco-2022-000945f02.jpg
case_images: PMC9150213_01_tsaco-2022-000945f02.jpg
case_images: F2
case_images: These findings, in tandem with Rigler's triad of gastric outlet obstruction, a gallstone in the duodenum and pneumobilia confirmed the diagnosis of a cholecystoduodenal fistula (figure 2).
case_images: PMC9150213_02
case_images: Gross images of the 5.5 cm gallstone extracted intraoperatively from the duodenum.
case_images: tsaco-2022-000945f03.jpg
case_images: PMC9150213_02_tsaco-2022-000945f03.jpg
case_images: F3
case_images: The large 5.5 cm stone was extracted carefully to avoid future distal obstructions from fragmentation (figure 3).