Answer to What’s Your Diagnosis

Radiological findings The plain radiograph (Figure 1) demonstrates dilated small bowel loops and air in biliary tree while the small bowel series (Figure 2) shows contrast in a fistulous tract arising from the lateral wall of the second part of the duodenum and communicating with the gall bladder fossa. CT scan of the abdomen (Figure 3 a & b ) demonstrated pneumobilia, par tial small bowel obstruction and a rim-like calcific density in the distal jejunum representing ectopic gallstone. A possible diagnosis of gallstone ileus was made. The classical radiologi cal triad involved in this condition is “Riglers triad” (partial or complete intestinal obstruction, air in the biliary tree and ectopic gallstone).