Upper Gastrointestinal Bleeding with Cholecystoduodenal Fistula

Abstract

Cholecystoduodenal fistula, caused by gallbladder stone, trauma, peptic ulcer disease, and malignancy, is an uncommon cause of upper gastrointestinal hemorrhage. I report a case of cholecystoduodenal fistula with upper gastrointestinal bleeding and gallbladder cancer. An 85-year-old male, complaining of hematemesis, was presented to the emergency department. Endoscopic examination revealed a 2 cm-sized ulceration at the first portion of the duodenum. Imaging studies, including CT, displayed cholecystoduodenal fistula accompanied with thickened gall bladder wall, air-fluid level in the gall bladder, and multiple hepatic metastatic lesions. The patient was referred for bleeding control surgery; however, he died due to recurrent and massive bleeding before surgery. Since bleeding from cholecystoduodenal fistula is associated with high mortality, early detection is critical for the prognosis. However, there is no typical symptoms and signs of cholecystodudodenal fistula. Additionally, diagnosis of cholecystoduodenal fistula using endoscopy alone was difficult. Therefore, it is recommended to use different diagnostic modalities, including enhanced CT.

Keywords

• biliary fistula
• gallbladder neoplasms
• gastrointestinal hemorrhage