Gallstone perforation and obstruction of the duodenal bulb.

A 69-year-old woman had a large gallstone eroded through the wall of the gallbladder and into the duodenum. The gallstone became fixed within the cholecystoduodenal fistula and produced a duodenal obstruction. At the time of the diagnosis of this problem, the patient had had a three-week period of epigastric pain and prolonged vomiting. She was treated by removal of the stone and cholecystectomy. The duodenal fistula was closed in two layers, and a gastrojejunostomy and a truncal vagotomy were carried out to protect the duodenal suture line. A leak from the duodenal closure developed on the fourth day, but this subsided spontaneously after 15 days with the use of sump drainage. Six months later, the patient is doing well and has a normal duodenum and gastrojejunostomy as shown by upper gastrointestinal barium study.