CASE HISTORY

The patient was admitted with attacks of intermittent vomiting over about 2 months. On examination she was a thin woman, and a straight x-ray of the abdomen showed gas in the common bile duct. Barium meal was negative. At laparotomy she was found to have two gallstones impacted in the upper art of the jejunum and one of them had already ulcerated through. The affected loop of jejunum was resected and the patient made a satisfactory recovery.

PATHOLOGY

The specimen consists of a part of the resected loop of jejunum. A window has been cut in the lower part to expose one of the impacted gallstones; the other one can be seen where its harp edge has perforated the jejunum above and to the left. This perforation appears to be fairly recent. There is a red edge but no obvious peritonitis around it. On the right-hand border there is another area of perforation with some local peritonitis, presumably a site where one of these stones had perforated the bowel wall.