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Correspondence: Elizabeth A. Mittendorf, MD, Department of Surgery, Malcolm Grow Medical Center, 1050 W Perimeter Rd, Andrews Air Force Base, MD 20762 (elizabeth.mittendorf@mgmc.af.mil).

Arch Surg. 2004;139:908.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Answer: Cholecystocolonic Fistula

Figure 1. Computed tomographic scan showing a hyperdense, rounded lesion with a hypodense center in the sigmoid colon.

Figure appears in full text version. Figure 1.

Figure 2. Specimen photograph revealing a large gallstone identified in the sigmoid colon.

Figure appears in full text version. Figure 2.

Cholecystoenteric fistula is a rare complication of biliary disease. The fistula usually results from inflammation associated with acute cholecystitis and occurs between the gallbladder and an adjacent hollow viscus. A second mechanism for fistulization is pressure necrosis from a large stone within the gallbladder lumen.¹ The duodenum is the most commonly involved portion of the intestinal tract, accounting for approximately 75% of these communications.² Once gallstones gain access to the small bowel, the majority are not large enough to cause an obstruction. Larger stones (>2.5 cm in diameter), however, can become impacted in the terminal ileum where there is a narrowing of the bowel lumen. The result is a gallstone ileus, which is . . . [Full Text of this Article]

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