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. 2019 May 29;3(3):305-306.
doi: 10.5811/cpcem.2019.4.42686. eCollection 2019 Aug.

An Unusual Presentation of Cholecystoduodenal Fistula: Abdominal Pain out of Proportion to Exam

Ryan McCreery  1 , Matthew Meigh  1
Affiliations

An Unusual Presentation of Cholecystoduodenal Fistula: Abdominal Pain out of Proportion to Exam

Ryan McCreery et al. Clin Pract Cases Emerg Med. .

Abstract

Cholecystoduodenal fistula (CDF) is a rare complication of gallbladder disease. Clinical presentation is variable, and preoperative diagnosis is challenging due to the non-specific symptoms of CDF. We discuss a 61-year-old male with a history of atrial fibrillation who presented with severe abdominal pain out of proportion to exam. The patient was diagnosed promptly and successfully managed non-operatively. This case presentation emphasizes the need to maintain a broad differential diagnosis for abdominal pain out of proportion to exam, with the possibility of a biliary-enteric fistula as a possible cause. It also stresses the importance of a multimodality imaging approach to arrive at a final diagnosis.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1
Image 1
Computed tomography angiography (axial view) demonstrating a wide soft tissue tract between the gallbladder and proximal duodenum (white arrow). Calcified gallstones seen entering the proximal duodenum and along the undersurface of the right hepatic lobe (black arrow).
Image 2
Image 2
Computed tomography angiography (coronal view) demonstrating a wide, soft tissue tract between the gallbladder and proximal duodenum, containing a small amount of air (white arrow).
Image 3
Image 3
Computed tomography angiography (coronal view) demonstrating two rim-calcified gallstones within the proximal jejunum (black arrows).
See this image and copyright information in PMC

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