We present a case of a woman in her 70s who arrived in the emergency department with signs of small-bowel obstruction. CT scanning revealed acute cholecystitis with a cholecystoduodenal fistula, pneumobilia and small-bowel obstruction possibly secondary to gallstone ileus although no radio-opaque gallstones were seen. The patient underwent an emergency operation and intra-operative findings revealed mechanical small-bowel obstruction of the proximal jejunum where a 4×2 x 3 cm gallstone was impacted. A laparoscopic-assisted enterotomy was performed with stone extraction and primary closure. The patient made a full recovery. A planned laparoscopic cholecystectomy and repair of cholecystoduodenal fistula is scheduled on elective basis.
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