This is an uncommon condition that occurs when a gallstone passes into the bowel through a fistulous connection (i.e., not through the common bile duct), often in the setting of chronic cholecystitis.
The stone travels distally in the bowel with large stones becoming trapped at the ileocecal valve.
It occurs most typically in elderly women and is marked by nausea, vomiting, obstipation, and crampy abdominal pain.
Pneumobilia (air in the bile duct on radiographic examination) occurs in 50% of cases.
The treament is surgery with an enterotomy (incision in the bowel) to retrieve the stone. Stones trapped in the duodenum should be milked back into the stomach to avoid performing a duodenotomy (surgical opening of the duodenum.)
Multiple stones can pass through a fistula and a diligent search of the entire bowel must be made to insure all stones have been removed.
Definitive treatment is a cholecystectomy and fistula repair at the time of stone retrieval if the patient can tolerate the procedure.