Gallstone ileus with a biliodigestive fistula

Background: A 34-year-old woman with breast cancer, metastasized to bone and brain, was admitted to our hospital with abdominal discomfort, nausea and constipation. Physical examination revealed a diffuse tender abdomen without bowel sounds. On laboratory examination, slightly elevated gamma-GT levels were found; gastroscopy showed 2 liter of bilious fluid. A nasogastric tube was placed