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To the Editor:
Cholecystenteric fistula is a rare complication of gall- stone disease. Stones may pass out from the gallbladder (GB) and obstruct the gastrointestinal tract (GIT).
A 54-year-old man was referred to our center with recurrent vomiting, constipation, and distension of the abdomen of 7 days duration. He was morbidly obese, was hypertensive, and had cirrhosis. He had acute renal failure because of dehydration. Evaluation by ultra- sonogram (US) of the abdomen showed a contracted GB with multiple calculi. There was air in the biliary tree (Fig. 1). A biliary-enteric fistula was suspected. MRI was performed. MRI showed presence of oral contrast (gadolinium) entering into the GB (Fig. 2). Chole- cystenteric fistula was diagnosed.
The patient vomited stones (lithemesis) and improved well. At that stage, we diagnosed the condition as du- odenal obstruction resulting from gallstones (Bouveret syndrome). However, on the fourth day of admission,...