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NewYork-Presbyterian Hospital Psychiatry
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Case of the Month - June 2017

This 71 year old female presented to the emergency department with sudden onset of abdominal pain with associated nausea, vomiting and chills for about 4 hours.

Question 1 : What’s wrong with these pictures?

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Answer 1:

There is a very large (3.4 x 2.3 cm to be exact) gallstone in the ileum (circles below) leading to small bowel dilation proximal to that (arrow below.)

Question 2: How does this happen?
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Answer 2:

Large gallstones typically cause bowel obstruction by entering the intestines by way of a biliary enteric fistula.

Question 3: How is this treated?
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Answer 3:

The treatment of this condition is typically surgical – to remove the stone, close the fistula and remove the gallbladder.

This patient was taken for surgery straight from the ED. She was discharged home in stable condition 6 days later.

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