AN 87-YEAR-OLD man with a known history of cholelithiasis was seen in the emergency department for acute onset of abdominal pain, vomiting, and diarrhea. On examination, he was afebrile, had a distended abdomen, and was tender to palpation in the left iliac fossa. Bowel sounds were active. The abdominal computed tomographic scan is shown in Figure 1. Following unsuccessful attempts at endoscopic fragmentation/extraction, a small left iliac fossa muscle-splitting incision was performed, the stone removed (Figure 2), and a colostomy formed.
A. Diverticular stricture
B. Cholecystocolic fistula and large-bowel obstruction due to gallstone ileus
C. Cholecystoduodenal fistula and small-bowel obstruction due to gallstone ileus
D. Obstructing colonic carcinoma
Corresponding author: Gerrard O'Donoghue, AFRCSI, Department of Surgical Research, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland (e-mail: firstname.lastname@example.org).
O' Donoghue GT, Winter D, Deasy J. Image of the Month—Quiz Case. Arch Surg. 2003;138(12):1391. doi:10.1001/archsurg.138.12.1391