This lady was admitted with a 4 day history of severe upper abdominal pain.
She was tender in the right upper quadrant with a positive Murphy's sign. An
ultrasound of the right upper quadrant confirmed the clinical suspicion of
symptomatic cholelithiasis. There was ultrasonographic evidence of a thickened
gall bladder wall with a single large gallstone seen impacted in Hartman's
pouch.
She was initially treated conservatively, but then had to undergo an emergency
laparotomy.
The image shows the intraoperative findings, what is seen?
What complication has occurred?
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