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