Abstract
A 70-year-old obese woman underwent a Hartmann’s procedure and partial cystectomy for a large relatively immobile recto-sigmoid tumour which adhered to the urinary bladder. The post-operative recovery was uneventful until the 9th postoperative day when her stoma ceased to function and she became nauseated. Nasogastric suction yielded over 2,000 ml of clear bile-stained fluid in 24 h. On the 12th post-operative day, she was re-operated and, in addition to some adhesions between loops of distal small bowel, a 3.5-cm diameter gallstone was found impacted in the terminal ileum. Through an enterotomy the gallstone was removed. No other stones were palpated. The gallbladder was small and fibrosed. It was impossible to palpate a biliary-enteric communication. Ten days after the second operation gastro-duodenoscopy was performed. A wide fistulous tract was seen arising from the dorsum of the first part of the duodenum. The patient was discharged 25 days after her second operation.