A large calcified gallstone in the second part of the duodenum is causing proximal dilation of the duodenum and significant dilation of the stomach in keeping with gastric outlet obstruction. A smaller gallstone is more proximally located. There is pneumobilia with a cholecystoenteric fistula evident. The small bowel is collapsed distal to the obstruction.
Bilateral ureteric stents in situ in appropriate position extending from the right renal pelvis and left renal calyces to the bladder. There is moderate dilatation of the renal pelvis bilaterally. Thickening of the tissues of the right flank likely represents previous instrumentation in relation to the previous perirenal abscess. No recurrent abscess is identified. Indwelling catheter in situ.
There is a midline anterior abdominal wall hernia containing non-obstructed small bowel.
No enlarged intra-abdominal lymph nodes.
Gastric outlet obstruction at level of the duodenum secondary to an ectopic gallstone from a cholecystoenteric fistula, in keeping with Bouveret syndrome.