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Updated: May 21, 2026
04:14
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Choledochal-duodenal fistula presenting as an upper GI bleed
Emma Lucy Marsdin1, Simon Kreckler, Abdulhalim Alzein
1General Surgery Department, John Radcliffe NHS Trust, Banbury, UK. emmamarsdin@doctors.org.uk
BMJ Case Reports
|June 8, 2012
Summary
Gallstones can cause rare but serious complications like Bouveret's syndrome, where a large gallstone obstructs the gastrointestinal tract. This case highlights successful surgical management of a giant gallstone causing a gastrointestinal bleed and obstruction.
Area of Science:
- Gastroenterology
- Surgical Case Report
Background:
- Gallstones are prevalent, often asymptomatic, but can lead to severe complications.
- Choledochal-enteric fistulation, a rare complication, carries a high mortality rate of 15-18%.
Observation:
- An 88-year-old male presented with an acute upper gastrointestinal bleed.
- Endoscopy revealed a large gallstone in the pylorus; CT confirmed a choledochal-duodenal fistula.
- Laparotomy identified a 6.2 cm gallstone fistulated into the duodenum (D1) and pylorus, causing obstruction.
Findings:
- The patient was diagnosed with Bouveret's syndrome, a rare form of gallstone ileus.
- Surgical intervention included subtotal cholecystectomy and stone removal via gastrostomy.
- Post-operative imaging confirmed duodenal patency and absence of leakage.
Implications:
- This case underscores the importance of considering rare gallstone complications in elderly patients with gastrointestinal symptoms.
- Successful surgical management of Bouveret's syndrome can lead to patient recovery.
- Early diagnosis and intervention are crucial for improving outcomes in complex gallstone disease.
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