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To the Editor.—The case of gallstone obstruction of the duodenum reported by Argyropoulos et al (Archives 114:333-335, 1979) is quite unusual, as the authors noted. However, we recently saw a patient with virtually the same pathology.
Report of a Case.—A 76-year-old woman was transferred from a nursing home to the White Plains (NY) Hospital Medical Center because of several days of nonbilious vomiting and dehydration. There was no history of abdominal pain, fever, chills, or jaundice, and no history of gastrointestinal (GI) disease. The remainder of her history was noncontributory. After rehydration, a temperature of 38.5 °C, leukocytosis, and epigastric pain developed. A flat plate roentgenogram of the abdomen showed a large, calcified density in the right upper quadrant, and pneumobilia. An intravenous cholangiogram was nondiagnostic. An upper GI series showed filling of the biliary tree with contrast material and a huge gallstone impacted in the duodenal bulb
WERTKIN MG, ALTMAN B, KADISH LJ, WOLIN C. Gallstone Obstruction of the Duodenum. Arch Surg. 1979;114(11):1346. doi:10.1001/archsurg.1979.01370350148021