Intragastric gallstone.

Abstract

The radiologist is well aware of cholecystoenteric fistulae with discharge of gallbladder calculi into the gastrointestinal tract and the acute obstructions that may thus develop. Gallstones have been seen within the duodenum, jejunum, ileum, and colon. McLaughlin and Raines (1) mention intragastric calculi in an excellent review of obstruction of the alimentary tract from gallstones. Their single case of an intragastric calculus was very similar to that reported here, but they presented no radiographic demonstration. We have seen no other reference to gallstones within the stomach. Case Report An 80-year-old while male first consulted a general practitioner in October 1950, because of right upper quadrant pain radiating to the heart. A cholecystogram at that time revealed what was interpreted as a poorly functioning gallbladder with evidence of a small solitary calculus with a calcific core and a radiolucent periphery (Fig. 1). Blood studies showed an unexplained anemia, with a hemoglobin of 40 per cent, which increased to 58 per cent on a blood-building regime. In January 1951, the patient was seen in consultation by one of the present authors (J.K.A.). He complained of weakness of four to six months duration and a gradual weight loss of 15 pounds in that time. For many years he had suffered from indigestion, especially following fatty foods, with occasional right upper quadrant pain. Bowel movements were sluggish, but there had been no clayey or tarry stools. For the past ten years there had been mild attacks of decompensation. The patient had never been jaundiced. Physical examination revealed some cardiac enlargement of left ventricular type. A slightly tender mass was palpable in the right upper quadrant of the abdomen. It was questionably nodular and compatible with a mass in either the gallbladder or the liver. The blood count showed a hemoglobin of 8.4 gm. (53 per cent), a red cell count of 2,850,000, white cells 2,550, with lymphocytes 40 per cent, neutrophils 40 per cent, eosinophils 4 per cent, basophils 1 per cent. The clinical impression was anemia, probably associated with a malignant tumor of the gallbladder. At operation (Feb. 18, 1951), the gallbladder was found to be slightly enlarged, grayish white, firm, but slightly friable. It was adherent to the transverse colon, duodenum, and stomach. It was thought that the patient probably had a carcinoma of the biliary tract but, since he was not tolerating surgery well, it was felt inadvisable to attempt any further exploration of the cystic and common duct. A wedge-section was taken from the fundus of the gallbladder and the abdomen was closed. The pathologic report was “severe chronic inflammation of the gallbladder area.” The patient was discharged on March 4 and until November of that year was followed symptomatically and also given a series of blood transfusions. On Nov. 15, 1951, he was readmitted following a gastric hemorrhage.