title: Choledocho-duodenal fistula encountered during emergency laparotomy for upper gastro-intestinal haemorrhage: what should be the surgical strategy?
abstract: Surgery remains the gold standard for the treatment of bleeding peptic ulcer after failed endoscopic therapy. It is unusual to encounter a bilio-enteric fistula complicating peptic ulcer disease during the emergency surgery for bleeding. We report a case of a 67-year-old man who presented with haemetemesis and hypotension. After failed endoscopy, a laparotomy was performed. A choledocho-duodenal fistula and a Forrest IIA ulcer was encountered. The bleeding ulcer was underrun and a subtotal cholecystectomy was performed. To the best of our knowledge, this complication has never been reported in the literature. We herein report such a case and discuss its management.
authors.affiliation: Department of Hepato-Biliary and Pancreatic (HPB) Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
authors.forename: N
authors.initials: N
authors.lastname: Periselneris
authors.forename: J J
authors.initials: JJ
authors.lastname: Bong
mesh_terms: D000368:Aged; D001649:Bile Duct Diseases / Q000150:complications* / Q000601:surgery*; D016154:Digestive System Fistula / Q000150:complications* / Q000601:surgery*; D004378:Duodenal Diseases / Q000150:complications* / Q000601:surgery*; D004638:Emergency Treatment; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000601:surgery*; D007813:Laparotomy; D008297:Male