An 86-year-old man admitted with small bowel obstruction. No previous abdominal surgery, but did have a small and easily reducible right inguinal hernia. The plain film shows a large gallstone in the gallbladder and another opacity in the left side of the abdomen. The diagnosis of gallstone ileus was considered at this stage. A repeat film showed no resolution of the small bowel obstruction and he underwent a laparotomy. At surgery, the small intestinal was obstructed and dilated proximal to a large gallstone impacted in the distal ileum.
The small intestinal was opened and the stone removed.
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