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Case Reports
. 2019 May 10;12(5):e228654.
doi: 10.1136/bcr-2018-228654.

Massive upper gastrointestinal bleeding: a rare complication of cholecystoduodenal fistula

Dinesh Kumar Vadioaloo  1 , Guo Hou Loo  2 , Voon Meng Leow  1 , Manisekar Subramaniam  3
Affiliations
Case Reports

Massive upper gastrointestinal bleeding: a rare complication of cholecystoduodenal fistula

Dinesh Kumar Vadioaloo et al. BMJ Case Rep. .

Abstract

A biliary fistula which may occur spontaneously or after surgery, is an abnormal communication from the biliary system to an organ, cavity or free surface. Spontaneous biliary-enteric fistula is a rare complication of gallbladder pathology, with over 90% of them secondary to cholelithiasis. Approximately 6% are due to perforating peptic ulcers. Symptoms of biliary-enteric fistula varies widely and usually non-specific, mimicking any chronic biliary disease. Cholecystoduodenal fistula causing severe upper gastrointestinal (UGI) bleed is very rare. Bleeding cholecystoduodenal fistula commonly requires surgical resection of the fistula and repair of the duodenal perforation. We describe the case of a previously healthy older patient who initially presented with symptoms suggestive of UGI bleeding. Bleeding could not be controlled endoscopically. When a laparotomy was performed, a cholecystoduodenal fistula was discovered and bleeding was noted to originate from the superficial branch of cystic artery.

Keywords: GI bleeding; general surgery; pancreas and biliary tract.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Oesophagogastroduodenoscopy image showing a large Forrest 2A ulcer at the anterior wall of the first part of duodenum.
Figure 2
Figure 2
Oesophagogastroduodenoscopy image showing successful through-the-scope clip placement and haemostasis.
Figure 3
Figure 3
Intraoperative image. The cholecystoduodenal fistula is visualised in this image (arrow). A 2 x 1 cm perforation at the anterior wall of the first part of the duodenum is seen, as well as the through-the-scope clip on the gallbladder mucosa.
Figure 4
Figure 4
Resected specimen. The specimen on the left is the gallbladder while the one on the right is the partial gastrectomy specimen with a penetrating ulcer at the anterior wall of the first part of the duodenum (arrow).
See this image and copyright information in PMC

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