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Nathan Hiatt, MD; Werner Salomon, MD
Temple Community Hospital Los Angeles

JAMA. 1981;246(7):735.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Cholecystoduodenal fistula is not uncommon—nor is small intestinal obstruction caused by gallstone. The site of gallstone obstruction is usually the narrow distal ileum; the less common jejunal obstruction almost always occurs where the lumen has been reduced by an adhesion.¹ A calculus large enough to occlude the lumen of the normal jejunum is unusual—that a stone of such size could pass through a narrow, distorted, fistulous tract is surprising—the combination seems worthy of recording.

Report of a Case.—

A 91-year-old woman was brought from an extended care facility in an obtunded state, with a history of vomiting for 24 hours and of gallbladder trouble one and two years ago. The patient was severely dehydrated, with a moderately distended but soft, nontender abdomen without palpable masses, somewhat hyperactive bowel sounds, and a well-healed, old, lower midline scar. Flat abdominal film showed dilated small loops. No air was . . . [Full Text PDF of this Article]

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