Choledochal-duodenal fistula presenting as an upper GI bleed.
Gallstones are common and largely asymptomatic, but can result in significant morbidity in a small proportion of patients. Choledochal-enteric fistulation is one such complication with an associated mortality of 15-18%. The authors present a case of an 88-year-old man admitted to the general medical ward with an acute upper gastrointestinal bleed. Oesophagogastroduodenoscopy found a large gallstone impacted in the pylorus and CT scan revealed a choledochal-duodenal fistula. At laparotomy it was found that a 6.2 cm gallstone had fistulated into D1 and the pylorus and impacted there, causing outflow obstruction - Bouveret's syndrome. A subtotal cholecystectomy was performed and the stone was removed by a separate gastrostomy. A radiological follow through study on day 14 showed contrast passing freely through the duodenum with no leak and the patient went on to make a slow, but uneventful recovery.
General Surgery Department, John Radcliffe NHS Trust, Banbury, UK. emmamarsdin@doctors.org.uk
Emma Lucy
EL
Marsdin
Simon
S
Kreckler
Abdulhalim
A
Alzein
Horace
H
D'Costa
D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000150:complications* / Q000209:etiology / Q000601:surgery; D001658:Biliary Fistula / Q000150:complications* / Q000209:etiology / Q000601:surgery; D042882:Gallstones / Q000150:complications* / Q000601:surgery; D006396:Hematemesis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications* / Q000209:etiology / Q000601:surgery; D007412:Intestinal Fistula / Q000150:complications* / Q000209:etiology / Q000601:surgery; D008297:Male