13 January 2025
: Case report
[In Press] Cholecystoduodenal Fistula Due to Gallstone Disease Masquerading as a Duodenal Ulcer Bleed: A Case Report
Unusual clinical course, Challenging differential diagnosis, Management of emergency care
Jayati Churiwala1ABEF, Hemant Sheth1E, Esam Aboutaleb1ACEFGDOI: 10.12659/AJCR.946743
Am J Case Rep In Press; DOI: 10.12659/AJCR.946743
Available online: 2025-01-13, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Abstract
BACKGROUND
A cholecystoenteric fistula (CEF) is a rare complication of gall stone disease. While a cholecystoduodenal fistula is the most commonly occurring bilioenteric fistulous communication, cholecystocolonic, cholecystogastric and choledochoduodenal fistulas have also been described.
CASE REPORT
A 73-year-old woman presented with a 1-week history of melena on a background of acid reflux and no abdominal pain. A gastroscopy revealed kissing D1 ulcers with excretion of pus. Following a CT scan of the abdomen, the patient was referred to the surgical team for the management of acute cholecystitis with a cholecystoduodenal fistula. She underwent an open cholecystectomy with fistula take-down and repair of the duodenum in the same admission. Following an uneventful postoperative recovery, she was discharged on an empirical course of H. pylori eradication therapy.
Recurrent episodes of acute cholecystitis or chronic cholecystitis can lead to adhesions between the gall bladder and adjacent viscus. Gall stone impaction then can cause pressure necrosis, leading to a fistulation between the gall bladder and the viscus. Rarely, this presents with massive upper-gastrointestinal bleeding. Imaging with ultrasound can reliably diagnose cholelithiasis, cholecystitis, and pneumobilia, but is unlikely to help in the definitive diagnosis of a bilioenteric fistula, which requires cross-sectional imaging.
CONCLUSIONS
Massive upper-gastrointestinal bleeding is a rare mode of presentation of CEF. Hemodynamic resuscitation and management of upper-GI bleed takes precedence, followed by definitive management of the CEF after establishment of the diagnosis.
Keywords: Case Reports; Cholecystitis, Acute; Fistula; Gallstones; Gastrointestinal Hemorrhage; Intestinal Fistula; Cholecystoenteric Fistula
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