This shows the undersurface of the liver to which the duodenum is adherent. The opened common
bile duct can be seen and above this there is an arrow marking a fistula between the gall bladder
and the duodenum.
This patient presented at the age of 87 with acute colicky abdominal pain and vomiting.
At operation a volvulus of the small intestine was found together with obstruction of the small
intestine by a gall bladder. At autopsy several days later, the fistula was demonstrated between a
fibrotic gall bladder (not well seen in the specimen) and the duodenum. The orifice in the
duodenum was approximately 1.5 cm in diameter.